Improving the oral health of children in Medicaid and CHIP is a priority for the Centers for Medicare & Medicaid Services (CMS) and for states across the nation. Oral health Performance Improvement Projects (PIPs) offer a key strategy for states with managed care programs looking to enhance their oral health care delivery systems. PIPs can be designed to improve oral health care utilization, quality, and/or timeliness among members enrolled in Medicaid-contracted health plans.

In partnership with CMS and Mathematica Policy Research, CHCS developed three practical resources to support state Medicaid agencies and their health plans in developing and implementing Medicaid oral health PIPs:

  1. Medicaid Oral Health PIPs: A Template (“PIP template”) — Guides states and health plans through the planning, implementation, and evaluation phases of an oral health PIP.
  2. Medicaid Oral Health PIPs: A How-To Manual for States — Provides guidance to states using the PIP template.
  3. Medicaid Oral Health PIPs: A How-To Manual for Health Plans — Provides guidance to health plans using the PIP template

States and health plans can use these resources to advance oral health PIPs designed to:

  • Facilitate data-driven, effective interventions in administration and at the point of oral health care delivery;
  • Maximize health plan strengths and leverage local oral health priorities and resources;
  • Ensure plan accountability through contract requirements; and/or
  • Leverage the expertise of external entities, such as External Quality Review Organizations, which already provide analytic support to state Medicaid managed care programs.

These resources were developed by the Center for Health Care Strategies for the Oral Health Initiative, a federal effort through the Centers for Medicare & Medicaid Services to advance improvements in children’s oral health by providing tools, performance data, and technical assistance to states and their oral health stakeholders.