Centers for Medicare & Medicaid Services (CMS), Center for Medicaid, CHIP and Survey & Certification

(CMCS) MEDICAID/CHIP ORAL HEALTH SERVICES FACT SHEET

Despite considerable progress in pediatric oral health care achieved in recent years, tooth decay remains one of the most preventable common chronic diseases of childhood. Tooth decay causes significant pain, loss of school days and may lead to infections and even death. CMS has been working with State and Federal partners as well the dental provider community, childrens advocates and others to improve access to pediatric dental care for children eligible under Medicaid and the Childrens Health Insurance Program (CHIP). Use of Dental Services by Children According to data collected for CMSs Early Periodic and Screening, Diagnostic and Treatment (EPSDT) benefit, approximately 38 percent of Medicaid eligible children received a dental service in 2008 (see Table 1). While this is an improvement over the 27 percent of children who received a dental service in 2000, it remains below the Healthy People 2010 goal of 56 percent of children having a dental visit within a year. Importantly, however, 17 States had dental service utilization rates above the average rate in Medicaid. Likewise, the use of preventive dental services also varied by States, with 10 States having at least 40 percent of children receiving a preventive dental visit in 2008. These finding are an indication that some States have identified ways of overcoming the barriers they face in improving access to oral health services. Data from the Medical Expenditure Panel Survey (MEPS) show Medicaid performance on access to dental services in a broader context.1 One study found that a larger percent of children with public coverage had at least one dental visit in a year than children without any coverage. While promising, these rates are still below those of privately insured children. This study also was useful in identifying children who may have greater problems accessing dental services than other children. For example, younger children (ages 2-5) and children in households where English is not the primary language, were less likely to have a dental visit in a year than their respective counterparts. Challenges & Opportunities The challenges to ensuring that Medicaid/CHIP eligible children receive the oral health services they are entitled to are varied. States note that enrolling sufficient dental providers and creating a dental home are continuing challenges. Administrative issues and low reimbursement rates are noted by providers as being a barrier to their participation in these programs.

OCTOBER 2010

To better understand how States are addressing these challenges, CMS reviewed eight States that were identified as having innovative practices and/or higher than average utilization rates.2 From these reviews, we confirmed what we suspected: there is no one size fits all solution to improving access to dental services. In fact, it appears that States that use multiple activities-- including collaboration, reducing administrative barriers, and an increase in fees, have been able to improve access. In addition to the barriers mentioned above by providers, children in Medicaid/CHIP may not have a dentist in their neighborhoods or lack transportation. They may face language barriers that make it difficult to access or receive services. Some families may not understand the importance of taking their children to a dentist for a check-up or of obtaining preventive care when there are no apparent problems. Moreover, some parents may not be aware that their children are eligible to receive dental services. Despite the many challenges, opportunities do exist to improve access to oral health services for children. Some States are collaborating with State provider organizations, dental schools, health departments and others as a way of increasing access. Collaborations can be effective in educating dentists about Medicaid and CHIP programs, assisting them in enrolling as a provider in the program and helping the providers staff navigate the unique Medicaid and CHIP administrative requirements such as confirming eligibility and filing claims. A number of States have increased provider rates as part of their strategies to increase childrens oral health access, although fiscal conditions are an obstacle to many States increasing rates. In addition, working together to educate beneficiaries about the importance of oral health and reinforcing that message through multiple channels (e.g., Head Start programs) can provide States with opportunities to reach families and provide consistent information.

Findings on Childrens Health Care Quality and Disparities. June 2009. Agency for Healthcare Research and Quality (AHRQ). <http://www.ahrq.gov/qual/nhqrdr09/nhqrdrchild09.pdf>28 September 2010.

2 Innovative State Practices for Improving the Provision of Medicaid Dental Services: Summary of Eight State Reports (October 2010) http://www.cms.gov/MedicaidDentalCoverage/

Fiscal Year 2008 Data Reported to CMS by States on Form CMS-416 Any dental service utilization
42% 38% 39% 34% 30% 39% 37% 34% 34% 21% 42% 42% 56% 38% 41% 46% 39% 38% 33% 36% 37% 44% 32% 37% 39% 25% 26% 46% 30% 47% 33% 43% 32% 44% 29% 36% 39% 33% 27% 46% 45% 38% 38% 49% 35% 51% 38% 45% 42% 24% 37% 38%

State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming National Average

State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming National Average

Preventive dental services utilization

38% 31% 34% 31% 25% 34% 30% 30% 29% 14% 39% 37% 46% 35% 37% 39% 36% 32% 28% 34% 32% 40% 32% 33% 32% 22% 22% 42% 25% 43% 28% 38% 28% 40% 23% 32% 37% 28% 22% 43% 42% 35% 34% 42% 34% 50% 35% 41% 36% 21% 32% 34%

State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming National Average

Dental treatment services utilization

18% 20% 20% 30% 16% 19% 15% 16% 14% 8% 20% 26% 30% 15% 20% 19% 18% 21% 17% 25% 16% 25% 14% 17% 17% 13% 13% 22% 12% 21% 18% 42% 15% 19% 12% 16% 18% 16% 13% 21% 22% 15% 19% 25% 18% 22% 21% 20% 42% 10% 19% 19.0%