Study Finds Gaps in Medicaid Coverage Guidelines for Asthma Care

Asthma affects many individuals across the United States and quality healthcare coverage plays a significant role in the management of the condition. A study, recently published in CDC’s Preventing Chronic Disease, found a lack of consistent and comprehensive coverage throughout the country, identified coverage-related challenges to accessing asthma care within states, and found substantial gaps between guidelines-based asthma care and coverage by state Medicaid programs.

The researchers explained that in 2015 the Asthma Guidelines-Based Care Coverage Project launched and aimed to track asthma guidelines-based care in state Medicaid programs. The Project tracked coverage for 7 categories of care and 9 barriers to accessing care, in addition to evaluating Medicaid state plans and other related information for every state Medicaid program.

“Guidelines-based care is key to properly managed asthma and can improve the quality of life for millions of Americans,” American Lung Association Chief Mission Officer Deb Brown, said in a statement. “Proper asthma management can be life or death for patients, and this new report finds that states can do more to provide the comprehensive and consistent care that patients with asthma need.”

The Project revealed that many programs do not cover the recommended categories of care and have inconsistent coverage across fee-for-service and managed care plans with the same state. This makes it more difficult for providers and patients to understand what asthma treatments and services are covered, according to the authors.

The authors suggested that the lack of consistency in coverage may create confusion and a lack of awareness among patients and providers on what asthma care is available. Furthermore, providers may not prescribe a treatment even if it is covered and reimbursed because they do know if it is covered under a patient’s plan.

“Successfully controlling asthma symptoms is critical, because when you can’t breathe nothing else matters,” Brown said. “This new report provides a better understanding of the care as well as the challenges faced by Medicaid patients with asthma, and what states can do ensure that everyone with asthma, including kids, has the opportunity to lead a healthy and full life.”

The study noted that the Project will continue to assess coverage of asthma care treatments and services to track changes over times. The authors suggested that by increasing available information about coverage and increasing the awareness of gaps in coverage, state Medicaid Programs may be encouraged to cover all 7 categories of asthma care without any barriers.