Given that Medicaid beneficiaries
are more likely to access
care than similarly situated
uninsured; Given that
the dental services children
and adults receive in
Medicaid are cost-effective;
Given that dental disease
is the single most common
chronic disease of children;
Given that parents consistently
cite dental as the number
one unmet health need
of their children; Given
that poor oral health
can affect a child’s
ability to learn and
an adult’s ability
to obtain a job due to
appearance; Given that
untreated oral disease
complicates medical conditions
like diabetes and heart
disease and may be associated
with pre-term low-birth
weight babies; Given
that oral disease can
jeopardize the health
of Medicaid-eligible
elderly and the disabled,
affecting the health
and well being of those
living in nursing homes;
Given that preventive
and routine dental services
save overall health care
dollars by avoiding costly
visits to the emergency
room, the dental community
agrees to the following
principles and recommended
policies:
Preserve the Federal Guarantee
of Medicaid Coverage, Services
and Consumer Protections
- Maintain a federal requirement
for dental services for EPSDT
Medicaid-eligible children ,
and extend medically necessary
coverage to adults.
- Ensure that preventive dental
benefits are excluded from cost-sharing
requirements.
Preserve the Federal Financing Role
in Medicaid
- Maintain the current federal-state
financing arrangement within
Medicaid and reject proposals
to establish caps on payments
to states.
- Update
the federal matching formula
to address changes in state economics,
and provide an enhanced match
for dental services to ensure
a state is able to adequately
cover these services for
Medicaid populations.
- Allow for flexibility within
states without diminishing
the existing federal-state partnership,
which includes federal requirements
and/or incentives to enhance
program effectiveness.
Assure and Maintain Access to Care
Through Adequate Provider Participation
- Provide incentives to states
to adopt Medicaid models
that mirror programs dental providers
work with in the private sector,
improve access for beneficiaries
and facilitate providers’ active
participation in the Medicaid
program.
- Ensure that
dental providers receive
fair and market-based compensation
for services provided and that
compensation is not decreased
by cost-sharing requirements.
- Consider
utilizing the private
market to provide additional
dental coverage options to higher-income
Medicaid beneficiaries or populations
not currently covered by the
Medicaid program (e.g., optional
dental health savings accounts),
and ensure that any private insurance
models offered to Medicaid beneficiaries
provide comprehensive dental
benefits.
- Maintain equal access
provision in federal law
to ensure that beneficiaries
within Medicaid have access to
dental services in the same way
as beneficiaries in the private
sector.
- Support dental
targeted case management
programs that utilize Medicaid
funds to capitalize on disease
management.
Use the Medicaid Waiver Process to
Foster Improvements and Innovation,
Not to Eliminate Federal Protections
or Reduce Benefits
- Ensure that medical necessity
criteria does not restrict or eliminate
coverage for oral health/dental care
that meets professional standards
and is clinically appropriate, as
determined by a dentist.
Improve the Integrity of Medicaid
- Eliminate fraud and abuse
within the program and ensure
necessary oversight to determine
adequate access to care is provided
to beneficiaries.
- Ensure
that the financing of
the Medicaid program is sound
and responds to market demands
and state economic needs.
Recognize the Interdependence of Medicaid
and the Public Health System
- Facilitate public-private
partnerships that improve
access for individuals who access
oral health care through a safety-net
provider. Such a partnership
may result in private contracts
between safety-net clinics and
dental providers and academic
dental institution clinics.
- Facilitate the establishment
of school-linked programs.
- Encourage programs that
value prevention and
disease management (to reduce
disease burden), are science
and evidence-based and invest
in strategies with strong potential
for long-term savings through
preventive care.
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