How to Improve Equity in Children’s Dental Care

In response to the U.S. Centers for Medicare and Medicaid Services (CMS) bulletin, “Aligning Dental Payment Policies and Periodicity Schedules in the Medicaid and CHIP Programs,” the Children’s Dental Health Project (CDHP) published “Medicaid Dental Guidance to States: An Opportunity to Aim for Equity” to provide direction on how state agencies can improve equity in children’s dental care.

Since May 2018, states have been leading efforts to expand access to dental care for children and adults who receive dental benefits through Medicaid. Barriers such as discrepancies between coverage and payment policies within state programs prevent enrollees from receiving the full spectrum of dental care their benefits require.

An example of this is a state’s program and insurance plans may use services outlined in periodicity schedules to limit a patient’s access to additional care even if it’s necessary. Or, if a state’s periodicity policies advise that every child should receive a caries risk assessment and frequency of care should be based on that assessment, the state and its contracted insurance plans may not actually pay for those services.

Removing these barriers will ensure children have full access to the dental services to which they are entitled.

“The CMS guidance is significant, as it urges states to lift these policy barriers, noting that what programs pay for should align with the minimum standards of care set forth at both the federal and state level,” says Colin Reusch, MPA, director of policy for the CDHP.

Providers may also face barriers, as some state programs have prior authorization policies that prevent timely care. The program’s policy may lack clarity on the process a provider must follow to deliver services that go beyond the state’s periodicity schedule.

The CMS report also supports breaking away from the traditional one-size-fits-all approach to dental care, as is does not meet Medicaid’s child-specific guidelines on the Early, Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Instead, CMS stresses the value of delivering individualized dental care.

“State benefit and EPSDT standards must serve as a floor, rather than a ceiling, for determining what care is most appropriate for individual children. Ultimately, the guidance clarifies that state Medicaid programs need to consider every child’s risk for caries, and provide what kids need in order to achieve good oral health. This may require more frequent visits or additional services for some kids compared to others,” says Reusch.

Additional approaches to help expand access to dental care include states considering legislation that would allow dental therapists to provide routine preventive and restorative care to Medicaid patients in Florida, New Mexico, North Dakota, Washington, and Wisconsin, and medical-dental integration, according to Pew Charitable Trusts.

Additionally, incentivizing health care providers to perform risk assessments and basic preventive services will also better serve children by identifying those in need or more frequent oral health care.

“As with any other aspect of health care, each person has unique needs. The mouth and teeth are no different. Our policies shouldn’t hinder the delivery of care that’s deemed necessary for one child just because other children might not need it. Medicaid and CHIP programs have a responsibility to ensure that each child’s health and oral health is addressed with services that meet their individual needs, so that they can be happy, healthy, and successful,” says Reusch.

For more information on the CDHP report, and to access resources such as a checklist for advocates, visit https://www.cdhp.org/resources/342-medicaid-dental-guidance-to-states-an-opportunity-to-aim-for-equity