Oral Health GuidelinesState Medicaid Early and Periodic Screening, Diagnosis, and Treatment guidelines: Adherence to professionally recommended best oral health practices
Section snippets
EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT DENTAL SERVICES
As a joint federal and state program, Medicaid is operated by states within broad federal requirements. States “can elect to cover a range of optional populations and services, thereby creating programs that differ substantially from state to state.―7 Although adult dental benefits are optional, all states are federally mandated under EPSDT to cover comprehensive dental services for children younger than 21 years.7 According to the Centers for Medicare and Medicaid Services (CMS), Baltimore,
METHODS
We identified state-level (and District of Columbia [D.C.]) EPSDT dental periodicity guidelines by using two approaches. In the first approach, we accessed many guidelines online, which is testament to their wide availability to EPSDT staff members, health care practitioners and parents. One of us (J.M.H.) performed the Internet searches in January 2012 by using the following search terms: state dental periodicity, state oral health periodicity, state dental EPSDT, state EPSDT periodicity,
RESULTS
Although all 50 states and D.C. had a dental component to their EPSDT guidelines, 33 of 51 (65 percent) maintained separate dental EPSDT periodicity schedules (Table 1 12, 17, 18, 19, 20, 21) and 18 (35 percent) did not (Table 2). For states that did not adopt a separate dental EPSDT periodicity schedule, five incorporated dental information into their Medicaid policy from the American Academy of Pediatrics (AAP), Elk Grove Village, Ill., periodicity schedule for medical screening,18 and one
DISCUSSION
Medicaid programs provide many oral health services for children in low-income families who otherwise would not have access to dental care. We identified state EPSDT dental periodicity schedules because of their potential to influence the oral health of children enrolled in Medicaid. We found that only 32 states and D.C. had EPSDT oral health guidelines, but the majority of those that did included more than 85 percent of recommended best oral health practices in their guidelines. EPSDT dental
CONCLUSIONS
The results of our study show that only 32 states and D.C. (65 percent) had a separate EPSDT oral health guideline. Most states with EPSDT oral health guidelines included more than 85 percent of the recommended best oral health practices, which are based on the AAPD guideline.12 Conversely, none of the states without a separate EPSDT dental periodicity schedule adopted the AAPD guideline. The age at which children are first referred to a dentist was the most divergent issue among state
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A comparative analysis of public and private dental benefit payer types for the provision and outcomes of root canal therapy on permanent teeth of children and adolescents in Massachusetts
2023, Journal of the American Dental AssociationComparative analysis of dental procedure mix in public and private dental benefits programs
2022, Journal of the American Dental AssociationCitation Excerpt :CMS grants autonomy to each Medicaid program to determine the services and associated frequencies that will meet minimum objectives for oral health among the eligible children living in their state.29 As state programs have refined their benefits for children in adherence of EPSDT over time, public coverage for oral health care has grown to look remarkably similar to private coverage for children’s oral health care, with more dentist participation and greater oral health care use.28,30,31 The Patient Protection and Affordable Care Act reinforced the essentialism of children’s oral health care with the inclusion of pediatric oral health care as an essential health care benefit; the same was not done for adults.31-33
Pediatric dental care use and parent- or caregiver-rated oral health among Alabama children enrolled in Medicaid
2020, Journal of the American Dental AssociationTrends in Pediatric Dental Care Use
2018, Dental Clinics of North AmericaCitation Excerpt :The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program was created in 1967 as a means to combat the effects of poverty on the health of children.8 This preventive services benefit program is mandated for children receiving Medicaid, but there is variability by states in the application of the EPSDT guidelines.9 Although the EPSDT services are mandated, access through provider participation in Medicaid is not guaranteed.10
Infant Oral Health: An Emerging Dental Public Health Measure
2018, Dental Clinics of North AmericaCitation Excerpt :This requirement fits in with IOH, and over the decades since Medicaid’s inception, states have adopted schedules that permit reimbursement for early dental intervention. The 2013 study by Hom and colleagues41 revealed that all 50 states and the District of Columbia had a dental component to their EPSDT program. However, only 32 states and the District of Columbia had established a separate periodicity schedule.
Disclosure. None of the authors reported any disclosures.
This research was supported by grant T32DE017245 from the National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Md., and by the American Academy of Pediatric Dentistry Samuel D. Harris Research and Policy Fellowship.
- 1
Dr. Hom is a pediatric dentistry resident, Department of Pediatric Dentistry, School of Dentistry, and a doctoral candidate, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
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Dr. Lee is a distinguished professor, Department of Pediatric Dentistry, School of Dentistry, and Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
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Ms. Silverman is assistant director, Pediatric Oral Health Research and Policy Center, American Academy of Pediatric Dentistry, Chicago.
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Dr. Casamassimo is a professor and chief, Department of Dentistry, Nationwide Children’s Hospital, Columbus, Ohio; chair, Division of Pediatric Dentistry and Community Oral Health, College of Dentistry, The Ohio State University, Columbus; director, Pediatric Oral Health Research and Policy Center, American Academy of Pediatric Dentistry, Chicago.