Kids in several states are missing their free Medicaid checkups, a trend that could impact the health and development of millions of low-income children. That’s the conclusion of the U.S. Department of Health and Human Services’ Office of Inspector General, which urged the federal government to “collaborate” with states to get more kids to the doctor’s office.

The finding is largely unchanged from a 2010 report that found 76 percent of kids in nine states didn’t receive a single screening. Every Medicaid program offers a set of services -- medical, vision and dental checkups -- for kids under its Early and Periodic Screening, Diagnostic and Treatment program. In 2013, some

32 million children were eligible and about 63 percent of those children received at least one screening. That number is above the 56 percent in 2006, but it is well below the 80 percent goal set by the Department of Health and Human Services.

Two states, California and Iowa, actually surpassed the department’s goal. In Iowa, about 81 percent of kids got a screening in 2013; in California, the number was reportedly more than 90 percent. The two states with the worst participation rates were Alaska, where 36 percent received a screening in 2013, and Ohio, where it was 33 percent -- a figure state officials say reflects data and reporting issues.

Source: Office of Inspector General

While missing a medical screening may sound fairly minor, there’s a well established link between poverty and chronic health issues, such as obesity and hypertension. There is a better chance of addressing those problems early in life, research shows, than later on in adulthood.

It’s hard to point to any single policy that states like California and Iowa have implemented to increase participation rates, in part because they use so many different tactics. But in Iowa’s case, the state Medicaid agency has a formal agreement with the public health department to use its locally based coordinators not only to conduct outreach but also to help connect patients to follow-up appointments. California has overcome the reporting issues many states face by creating a separate billing category for the Medicaid wellness screenings and pushing for compliance through state agencies and medical groups.

The latest report from the Office of Inspector General praised a guide from the Centers for Medicare and Medicaid Services that shares states’ best ideas for increasing screening rates. Some states, for example, used websites to educate providers and parents. And Rhode Island offered gift certificates for pizza and movie tickets to get more kids to the doctor.

Following in the footsteps of more successful states, Ohio is trying to increase the percentage of kids receiving screenings by writing reporting, monitoring and incentivizing requirements into contracts with managed care providers.

Perhaps the biggest barriers to increasing participation, though, are issues that disproportionately affect low-income people: transportation to screenings and inflexible work schedules, among others. One way of addressing both those problems is through medical homes, says Neva Kaye, the managing director of Health System Performance at the National Academy for State Health Policy. Medical homes are essentially teams of doctors and other medical professionals charged with coordinating the care for a certain population. Medical homes allow for more hours, open scheduling and weekend times in states willing to make the investment. “Increasing screenings would be at the core of a medical home,” Kaye says. “I do think giving the providers resources to do that will ultimately help improve the screening rate.”