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Advocacy
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Financial barriers remain the primary reason for lack of access for necessary oral health services. As evidence, children with public or private dental insurance are 30 percent more likely than uninsured low-income children to have a preventive dental visit. However, annual dental expenditures in the U.S. exceeded $70 billion in 2002 and only half of the U.S. population has some type of third party dental coverage (significantly lower than those with medical insurance). Low-income children remain at highest risk for poor dental health. Therefore, maintaining dental coverage within in Medicaid and SCHIP remains critical for low-income families.
March 2007
SCHIP Reauthorization Recommended Dental Program Modifications (pdf)
12 national dental organizations collaborated on these principles calling for:
Establishing a Federal Guarantee for Dental Coverage in SCHIP;
Developing a Dental Wrap-Around Benefit in SCHIP;
Supporting Ongoing Outreach Efforts to Enroll All Eligible Children in SCHIP;
Enacting Mechanisms to Ensure Reliable Data Reporting on Dental Care in SCHIP.
CDHP Publications:
January 2007
Successful State Medicaid Dental Reforms
While many state Medicaid dental programs have remained stagnant and ineffective in assuring access for low-income children, a few states have instituted remarkable reforms that have increased both dentist participation and dental access for child beneficiaries.
With support from Greater Hartford Legal Aid and CDHP, Don Schneider, DDS MPH (former Chief Dental Officer at the federal Medicaid agency) has developed summaries describing Medicaid innovations in six states. These reports explain what each state did to improve access and how much improvement they obtained through reform. We acknowledge with gratitude the assistance of State dental Medicaid program officials in compiling these reports. Click here for reports on innovation successes in:
DELAWARE (pdf)
INDIANA (pdf)
MICHIGAN (pdf)
SOUTH CAROLINA (pdf)
TENNESSEE (pdf)
VIRGINIA (pdf)
January 2007
Implications for Children's Dental Medicaid Policy in the Deficit Reduction Act of 2005 (pdf)
The Deficit Reduction Act of 2005 (DRA) made sweeping changes within the Medicaid program, many of which were previously only possible through a federally approved waiver. Many of the original tenets of the Medicaid program were discarded in DRA by providing the opportunity to eliminate such standards as "statewideness" and "comparability." Building on previous DRA briefs issued by the Children's Dental Health Project this brief, excerpted from a technical analysis of the law, details the implications of these reforms for children's dental health policy.
December 2006
SCHIP Coverage Critical to Dental Access, According to New Study (pdf)
A study published in the October issue of Pediatrics found that access to dental care appears to have nationally improved for children with family incomes consistent with SCHIP eligibility during the program's first six years.
November 2006
State Children's Health Insurance Program (SCHIP): A Decade of Optional Dental Coverage for Kids
(pdf)
Because Congress only authorized SCHIP for 10 years, it requires reauthorization in 2007. Congressional leaders will be looking to the successes and failures of SCHIP to identify modifications. In an effort to prepare dental advocates for this process, this brief provides information on SCHIP dental performance to date.
August 2006 (revised from June 2006)
What New CMS Guidance on DRA Means to Children's Dental Care (pdf)
The Centers for Medicare and Medicaid Services (CMS), the agency responsible for implementing the Deficit Reduction Act (DRA), has released guidance on the new Medicaid provisions. Three Medicaid changes of particular interest to the dental community are citizenship verification requirements, alternative benefit packages, and cost sharing options. This brief provides details on recently released CMS guidance on these three issues to assist children's oral health advocates in working with their states.
August 2006
Medicaid innovators are paving the way for new state changes in dental Medicaid (pdf)
The current momentum to modernize Medicaid may be catching on in the states. What does this mean for children's access to dental services? It isn't completely clear yet, but trends are emerging from the early adopters and those in the planning phase. The Centers for Medicare and Medicaid Services (CMS) recently released guidance for Medicaid Transformation grants to states. The grants, authorized by the Deficit Reduction Act of 2005 (DRA), are available to assist states to, "fund research and design ways to transform their Medicaid systems and to increase the quality and efficiency of care." This federal funding gives states the financial incentive to investigate new strategies for serving Medicaid populations.
June 2006
Keeping Up with Medicaid Changes in States: A Guide for Child Oral Health Advocates (pdf)
Recent changes made by Congress through DRA have shifted many Medicaid options that previously would only have been available as a waiver to be an option through a State Plan Amendment. These changes provide less oversight by state legislatures, as many states require approval for a waiver application and fewer need legislature clearance for an SPA. This shift may also change the opportunity for public comment. Staying informed about the process for Medicaid changes and seeking out opportunities to comment on these changes is critical for dental providers to influence policy decisions that shape access to dental care for vulnerable children.
May 2006
The Deficit Reduction Act of 2005: What Does It Mean For Children’s Dentists? (pdf)
The Deficit Reduction Act of 2005 (DRA) includes a number of changes in Medicaid that are designed to cut program spending by $7 billion over the next five years. While making these cuts, Congress also stated its intention to keep the pediatric EPSDT benefit intact. This is important to dentists because EPSDT contains Medicaid's comprehensive dental benefit for children from birth to age 21. Putting the projected savings side-by-side with the guarantee of continued coverage raises the question for dentists: "How can Medicaid both cut costs by billions and still keep benefits unchanged?"
May 2006
Top Ten Questions To Ask State Leaders about Medicaid and Coverage for Children’s Oral Health (pdf)
Although dental caries remains the single most common chronic disease of US children and adolescents, many health policies fail to feature oral health care as a critical component of overall pediatric health care. The new Deficit Reduction Act of 2005 (DRA) provides states with new opportunities to change the way they deliver dental care to low-income children in Medicaid. This fact sheet was developed to help you ask questions of policymakers so that you can keep abreast of possible changes in your state.
May 2006
Medicaid Flexibility in the Deficit Reduction Act of 2005: What Does It Mean for Children's Oral Health? (pdf)
In February, President Bush signed into law the 2005 budget reconciliation bill entitled the Deficit Reduction Act of 2005 (DRA). Budget bills rarely raise much interest or seem relevant to the dental care of children. However decisions impacting children's access to dental care are many times determined in the budget process rather than through more traditional legislative activities. As the title implies, DRA includes numerous mechanisms for reducing the federal deficit, including providing states with new budget cutting "flexibilities options" in Medicaid.
March 2006
Understanding Medicaid State Waivers and their Impact on Children's Dental Coverage (pdf)
With Medicaid continuing to dominate many governors' agendas, many governors are looking to the federal government for options to contain state costs by significantly altering the basic structure of children's coverage. Medicaid waivers, particularly "1115 waivers," have become a primary method for some states to contain Medicaid expenditures. While these waivers were once a strategy for expanding Medicaid coverage, they have now become a battleground for maintaining fundamental pediatric services.
October 2005
CDHP Special Medicaid Report (pdf)
Does Flexibility Spell Loss of Dental Benefits? How proposed Congressional changes to EPSDT will impact "special" populations.
August 2005
Dental Benefits in the Medicaid/CHP+ Streamlining HIFA Waiver (pdf)
Under contract with the State of Colorado, CDHP developed this document for states that are considering Medicaid reform under the federal waiver process (Health Insurance Flexibility and Accountability Program).
The document, prepared by Founding Director Burt Edelstein DDS MPH, Consultant Don Schneider DDS MPH and Washington Director Anne De Biasi MHA, is of interest for all states because it develops a proposed benefit design that honors the nature of pediatric oral health and dental care and respects legal requirements in Medicaid EPSDT and SCHIP.
This report describes how pediatric oral conditions (especially caries) shape program requirements, how past performance and lessons learned from state programs suggest useful reforms, why cost sharing reduces access, what professional guidelines are available, and how earlier proposals to reform Medicaid can inform current efforts.
Six appendices describe (A) a model tiered pediatric benefit structure consistent with EPSDT requirements; (B) background information on Medicaid and EPSDT dental programs; (C) model Medicaid benefit design from the CMS Guide to Children's Dental Care in Medicaid; (D) increasing access through public-private partnerships; (E) state options in contracting dental care in Medicaid; and (F) cost-effectiveness of preventive dental services for children.
July/August 2005
Medicaid Reform: Implications for Poor Children’s Dental Care
The US Congress and states across the Nation are currently involved in “Medicaid Reform” efforts that aim to reduce costs while “modernizing” this venerable program. This series of regular updates, beginning in July 2005, provides detailed reports on actions taken by Federal and State Governments as they may affect access to dental care for low-income children. July 2005 Medicaid Report (pdf). August 2005 Medicaid Report (pdf).
February 2005
Cost Effectiveness of Preventive Dental Services (pdf)
Federal budget cuts in Medicaid threaten to erode core dental services. Citing research that shows the effectiveness and cost benefits of children's preventive dental services, this Children's Dental Health Project's policy brief highlights the need and rationale for children's dental services to remain in the Medicaid program.
Other Resources:
Georgetown University, Center on Children and Families
Medicaid/SCHIP Dental Association
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