On May 4, 2018, Center for Medicaid and CHIP Services (CMCS) Acting Director Timothy Hill released an Informational Bulletin calling for states to review their Medicaid and CHIP payment policies to ensure alignment with pediatric dental periodicity schedules. The Bulletin followed up on a 2016 U.S. Department of Health & Human Services Office of the Inspector General (OIG) report which found that three-quarters of children covered by Medicaid in the four states it assessed were not receiving required dental services. Additionally, two states had payment policies that did not allow for payments to be made for services children are intended to receive based on their established periodicity schedules. For example, one state’s schedule specified children should receive biannual fluoride treatments and dental cleanings starting at six months of age, yet the state’s policies would only pay for these services for children one and older.
Noting that 46 million children rely upon Medicaid and CHIP for their dental care, Acting Director Hill also reminded states that their periodicity schedules “should be treated as a ‘floor’ for coverage of dental services, not a ‘ceiling.’” Left untreated, tooth decay can necessitate costly—and preventable—emergency room visits and have long-term health and well-being implications for children.
Encouraged by federal efforts such as the Children’s Oral Health Initiative, states have made progress in opening up dental access for Medicaid-covered children over the past decade, though significant disparities with children covered by private insurance remain. A Manatt analysis of CMS-416 data found that nationally, over 19 million children ages 0 to 20 (48.2% of those covered) received dental services through Medicaid in FY2016, a 26% increase from 2011. Three-quarters of states (38) reported increases in their child dental utilization rates under Medicaid/CHIP between FY2011 and FY2016 (Figure 1).
Figure 1
By FY2016, for the first time, three states—Hawaii, Texas and Connecticut—all had dental utilization rates exceeding 60% for children on Medicaid (Figure 2). (By comparison, however, according to a study by the American Dental Association (ADA), 37 states had utilization rates in excess of 60% for children with private dental benefits.) Florida, Indiana, Montana and Hawaii reported substantial dental utilization rate increases over the period, while Wisconsin, Missouri and Ohio continued to have the lowest utilization rates among states. Seven of the ten bottom-performing states had Medicaid fee-for-service reimbursement rates among the ten lowest in the country, per data published by the ADA.
Figure 2
Data Notes: Manatt analysis of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) CMS-416 data for FY2011 and FY2016 made available by CMS here. Analysis does not include North Dakota, for which data was not available in FY2016. “States” include the District of Columbia. Dental utilization rates calculated for children (0–20) eligible for EPSDT for 90 continuous days who receive any dental service during the fiscal year.
