Tooth decay is the most common childhood disease — in fact, it is five times more common than asthma, and nearly one-quarter of all preschool-age children in the U.S. have experienced tooth decay. Dental health in children is vital, especially given the long-term and pervasive ways tooth decay can affect a child’s life — for example, missed school days and increased risk for costly dental disease as adults, as well as systemic disease and reduced employability.
Even though oral health care is fully covered under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment benefit, less than half of all Medicaid-enrolled children receive any dental service in a given year. Barriers to oral health care access include:
- A lack of oral health care provider participation in Medicaid;
- The reluctance of participating oral health care providers to treat young children due to providers’ inexperience or child behavioral issues;
- Awareness gaps among Medicaid-enrolled families about available dental benefits and how to utilize them; and
- Transportation issues and difficulty scheduling/attending office appointments due to competing work schedules; and other barriers.
At the federal level, the Centers for Medicare & Medicaid Services (CMS) launched the National Oral Health Initiative in 2010 to support states in improving preventive dental service utilization among Medicaid-enrolled children. Since then, many states have undertaken efforts to increase access to preventive dental care for children in Medicaid. The following examples are drawn from participants in the Center for Health Care Strategies’ seven-state Medicaid Oral Health Learning Collaborative, funded by the DentaQuest Foundation.
1. Educating and Engaging Consumers
To help educate consumers on the importance of oral health care for children, states are using tools such as CMS’ Think Teeth materials. Virginia’s Medicaid agency includes these in toothbrush goodie bags distributed at various events and health fairs. Washington’s Access to Baby and Child Dentistry (ABCD) program targets Medicaid-enrolled children under age six, with a goal of ensuring that they have access to dental care. ABCD offices distribute CMS’ Think Teeth educational materials to Women, Infants and Children (WIC) offices, early childhood programs, and tribal clinics throughout the state.
2. Providing Information and Services in Non-Dental Settings
Medicaid beneficiaries may not be connected to a dentist’s office or may be unaware of their dental benefits, so offering information and basic services in non-dental settings can be an effective strategy. Through New Hampshire’s WIC Pay-for-Performance program, women and young children receive preventive oral health services from a registered dental hygienist at three WIC locations, as well as referrals to Medicaid-participating dentists.
3. Using Data to Identify High-Risk Children
In Los Angeles County, California, children enrolled in Medicaid who have not been to a dentist in the past year are being identified for outreach and engagement. Through an examination of dental claims, the state and its contracted dental plans are compiling lists of children who are not utilizing dental services, and engaging pediatric primary care providers to refer those children to a dentist at their next well-child visit.
4. Enacting Policy Changes
Some states have implemented policy changes to increase access to and provision of oral health care. Arizona’s Medicaid program amended policies to allow for the application of fluoride varnish by primary care providers, and to auto assign Medicaid beneficiaries up to 21 years of age to a dental home. Minnesota is currently working with stakeholders to introduce legislation increasing reimbursement rates for dental services and reducing administrative barriers to provider participation in the program.
5. Establishing ‘Dental Homes’ for Children
Dental home programs allow a Medicaid-eligible child to establish an early relationship with a dental provider. Texas is working on expanding its First Dental Home program, which offers a package of dental services – including caries risk assessment, dental prophylaxis, and application of fluoride varnish – targeted at improving the oral health of children from six to 35 months of age.
Many states have made considerable progress in improving access to oral health care for low-income children: from 2007 to 2011, almost half of all states achieved at least a 10 percentage point increase in the proportion of children enrolled in Medicaid and CHIP that received a preventive dental service. As states seek to capitalize on this momentum, they can look to CMS’ Oral Health Initiative for technical assistance, training materials, oral health resources, and analytic tools to track improvements in utilization and outcomes. Through their ongoing efforts to improve health care quality and access for children in Medicaid, states must continue to keep in mind that oral health is integral to overall health and long-term wellbeing.