Although oral health care is included in Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, less than half of Medicaid-enrolled children receive any dental service in a given year. The consequences of unmet oral health care needs for children can include missed school days, chronic pain, poor self-esteem, and diminished general health, as well as increased risk for costly dental disease and tooth loss as adults.
To address persistently high rates of tooth decay and the underlying poor access to oral health care among the nation’s low-income children, the Centers for Medicare & Medicaid Services launched its National Oral Health Initiative (OHI) in 2010. The OHI requested that each state develop a pediatric State Oral Health Action Plan (SOHAP), with strategies to increase:
- By 10 percentage points, the proportion of children ages one to two enrolled in Medicaid or CHIP who receive a preventive dental service between Federal Fiscal Year (FFY) 2011 and FFY 2015; and
- By 10 percentage points, the proportion of children ages six to nine enrolled in Medicaid or CHIP who receive a dental sealant on a permanent molar tooth over a period TBD.
Through the OHI Learning Collaborative, CMS provided technical assistance to five state Medicaid agency and stakeholder teams – including Florida, Kansas, Michigan, Utah, and Washington, DC – as they developed, implemented, and assessed SOHAP strategies for improving children’s oral health. In partnership with Mathematica Policy Research, the Center for Health Care Strategies (CHCS) provided group and individual technical assistance for the five participating states.
Under the OHI, CHCS also worked with CMS and Mathematica to develop and help states use a variety of resources to advance oral health for Medicaid-enrolled children. These included tools for developing and implementing oral health-focused Performance Improvement Projects (PIPs).