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New brief encourages states aligning with CMS to improve access for children

March 15, 2019

Washington — A new report from the Children's Dental Health Project outlines the role dentists and others can play in improving access to dental care for children.

The report, Medicaid Dental Guidance to States: An Opportunity to Aim for Equity, is CDHP's response to the Centers for Medicare & Medicaid Services' May 2018 informational bulletin, Aligning Dental Payment Policies and Periodicity Schedules in the Medicaid and Children's Health Insurance Programs. The CMS bulletin discussed the importance of state Medicaid and CHIP programs and encouraged states to align their dental periodicity and payment policies.

"CDHP has long urged for Medicaid and CHIP programs to better align their periodicity and payment policies to better reflect clinical guidelines for preventing and managing tooth decay," wrote Meg Booth, CDHP executive director, in a blog post on the organization's website. "The clarifying guidance promotes equity in children's oral health care by ensuring more kids get individualized dental care. Medicaid's child-specific benefit — Early and Periodic Screening, Diagnostic and Treatment — was designed with individualized care as its driving force. In Medicaid, or CHIP programs that use EPSDT, kids must have timely access to appropriate care, even if that care goes beyond what's outlined in the Medicaid/CHIP dental periodicity schedule or state plan. This standard falls in contrast to the 'one-size-fits-all' approach to oral health care often used today."

Highlights from the report include:

  • Encouraging the use of the American Academy of Pediatric Dentistry's Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents that was supported by the ADA and American Academy of Pediatrics. (The report also cites the Dental Quality Alliance's User Guide for Pediatric Measures.)
  • Details on the importance of shifting to a risk-based or individual care model to more efficiently manage oral disease.
  • Calling for states to clearly define Medicaid and CHIP benefits and "set expectations for how contracted insurers administer those benefits, while upholding the programs' goals."

The report also offers the following resources for stakeholders to help make Medicaid and the Children's Health Insurance Program more responsive, accountable and oriented toward equity in children's oral health care.

  • A video explaining the CMS bulletin and CDHP's brief.
  • A fact sheet on oral health risk assessments.
  • Recording and slides from an August 2018 webinar that breaks down the CMS bulletin.

Visit CDHP.org for more information.