In response to the U.S. Centers for Medicare and Medicaid Services (CMS) bulletin, “Aligning Dental Payment Policies and Periodicity Schedules in the Medicaid and CHIP Programs,” the Children’s Dental Health Project (CDHP) is providing further guidance on how state agencies can improve equity in children’s dental care. As part of efforts to increase access to oral health services, the nonprofit advocacy group has issued its “Medicaid Dental Guidance to States: An Opportunity to Aim for Equity.”
In recent years, state programs, professional organizations and advocacy groups have been leading efforts to expand access to care for children and adults who receive dental benefits through Medicaid. Yet, barriers within state programs — such as discrepancies between coverage and payment policies — prevent enrollees from receiving the full spectrum of oral care their benefits allow. An example would be a state insurance program that uses services outlined in periodicity schedules to limit a patient’s access to additional care, even if it is deemed necessary. Removing these barriers will ensure children have full access to the dental services to which they are entitled.
The CMS report also supports breaking away from the traditional, one-size-fits-all approach to dental care, as is does not meet Medicaid’s child-specific guidelines on the Early, Periodic Screening, Diagnostic and Treatment benefit. Instead, CMS stresses the value of delivering individualized dental care. Incentivizing providers to perform risk assessments and basic preventive services will also better serve children by identifying those in need of more frequent oral health care.
“Our policies shouldn’t hinder the delivery of care that’s deemed necessary for one child just because other children might not need it,” notes Colin Reusch, MPA, director of policy for CDHP. “Medicaid and CHIP programs have a responsibility to ensure that each child’s health and oral health are addressed with services that meet their individual needs.”
From Decisions in Dentistry. May 2019;5(5):8.