dental coverage writeup homan

8/14/2019 Dental Coverage Writeup Homan

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Increasing Missouri Childrens Dental Coverage Policy Position Paper

Missouri General Assembly

July 2007

Mary E. Homan, MA, Saint Louis University School of Public Health

The National Crisis of Dental Care for Children

Lack of dental coverage is a serious problem facing adolescents in Missouri. Lack of

health insurance exacerbates dental problems and dental coverage for Missouris children. Poor

oral health causes American children to lose 850,000 school days per year.1

Dental caries is the

single most common chronic disease of childhood, occurring five to eight times as frequently as

asthma, the second most common chronic disease in children. 80% of tooth decay occurs in only

25% of children- primarily children from low income families.2 31% of 6-8 year olds with tooth

decay go without treatment and almost 80% of tooth decay in poor children is untreated.

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African-American children, regardless of dental insurance type, were significantly less likely

than white children to have received preventative dental care. 4 2.6 times as many children did

not have dental insurance compared with those who had medical insurance.5 22.1% of US

children lacked parentally reported dental insurance coverage in the preceding year.6 26.9% did

not have a routine preventive dental visit.7 5.1% had parentally perceived unmet need for

preventive dental care.8 Only 58% of federally qualified health center grantees provide dental

services. Thus, nearly half of the 4 million children who obtain their routine health care in

community health care centers have no access to dental care in their health center.9,10

Impact of Lack of Coverage for Missouri Children

In Missouri, 45 percent of children hospitalized for preventable dental conditions and 53

percent of children who visit emergency rooms for dental related illnesses are MC+/Medicaid

Recipients.11

Nationally, only 20% of Medicaid-eligible children received routine preventive

dental services in 1993, compared to the 63% of the total children population who see a dentist

annually.12

71% of Missouri dentists do not take MC+/Medicaid patients at all.13

38% of

Missouri's 115 counties have no dentist willing to accept MC+/Medicaid patients.14 Citizens for

Missouris Children conducted a telephone survey in the St. Louis area in February 2000 using a

Department of Social Services list of MC+/Medicaid dental providers. Only 30% of the dentists

in private practice from the list were actually accepting any MC+/Medicaid.15 A child in the

Missouri Head Start program has an average of 6.5 weeks for a dental appointment. 16


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Current Policy on Dental Coverage

Dental services for the State Children's Health Insurance Program (SCHIP) are an

optional benefit under Title XXI of the Social Security Act for all children up to age 19. Dental

services are available to all Medicaid eligibles. In the regions of the state where MC+ managedcare has been implemented, child enrollees have dental services available through the MC+

managed care health plans.17 Dental services include: treatment of the teeth and associated

structure of the oral cavity; preparation, fitting and repair of dentures and associated appliances;

and treatment of disease, injury or impairments that affect general oral health. The Medicaid

plan provides payment for dental services for eligible fee for service Medicaid\MC+ recipients.

All dental services are covered by the MC+ health plan for children under 21. 18

Policy Recommendations for MissouriMC+/MEDICAID contracts should require plans to put traditional safety-net dental

providers and dental clinics in the provider network. The Department of Social Services should

require MC+/Medicaid Managed Care Organizations to include existing resources in its provider

networks, such as dental hygienists, community health nurses, health educators, WIC program

nutritionists, and pediatricians. Increase MC+/Medicaid reimbursement rates for all dental

procedure codes to 80%. Decrease in the administrative burden for dental professionals

participating in MC+/Medicaid. Establish an Oral Health Resource Program within the

Department of Health, Bureau of Dental Care, in collaboration with the Division of Medical

Services.

Action Requested

Legislators especially should engage in more aggressive outreach to give low-income

children greater access to dental services. Encourage dental insurance companies to pay for

dental sealants for children. Health Departments, particularly the State Department of Health

and Senior Services should increase oral health literacy in school curricula, particularly in the

primary grades. Increase the implementation of water fluoridation in new communities.

Increase the percentage of children and adolescents using fluoridated toothpaste, fluoride tablets,

and/or fluoride mouth rinses, particularly in areas with unfluoridated water.


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Expected OutcomesWhen Missouris children begin to utilize dental care more frequently, we will see fewer

school days missed due to dental caries, less utilization of emergency departments for care of

severe dental problems which will mean less tax-payer money used to reimburse emergencydepartment physicians. If insurance companies increase coverage, fewer children will need to

see specialists for progression of gum disease costing insurance companies less. Parents will

miss fewer work days taking care of sick children. Children will be healthier and happier and

will not need to obtain serious dental work at a young age. Overall, protecting Missouris

children by assisting in providing for dental coverage and working with payment reimbursement

plans for dentists and insurance companies will save the state of Missouri hundreds of thousands

of dollars by participating in preventative care as opposed to treatment of illness.


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Charts Illustrating Problem of Dental Coverage for Children

Percentage of U.S. Children Age 5-17 Who Have Had Cavities, 1988-94.

Data Source: National Center for Health Statistics, CDC. Third National

Health and Nutrition Examination Survey, 1988-1994.


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Works Cited

1 Gift, Recine S.T. & Larach, D.C, Social Impact of dental problems and visits,American Journal of Public

Health, 82; 1663-1668.2

Edelstein, B.L., Public Financing of Dental Coverage for Children: Medicaid, Medicaid Managed Care, and

State Programs, Paper prepared for the Reforming States Group, San Francisco, CA, 1997. Available at:

http://www.aads.jhu.edu/legislative_affairs/ public_financing_of_dental_cover.htm.3 Vargas, C.M., Crall, J.J., & Schneider, D.A., Sociodemographic distribution of pediatric dental caries:

NHANES III, 1988-1994,Journal of the American Dental Association, 129: 1229-1239.4

Lewis C, Mouradian W, Slayton R, Williams A., Dental insurance and its impact on preventive dental care

visits for U.S. children,Journal of the American Dental Association, 2007 Mar;138(3):369-80.5Ibid.6

Liu J, Probst JC, Martin AB, Wang JY, Salinas CF., Disparities in dental insurance coverage and dental care

among US children: the National Survey of Children's Health, Pediatrics, 2007 Feb; 119 Suppl 1:S12-21.7Ibid.8Ibid.9

Edelstein BL., Public and clinical policy considerations in maximizing children's oral health, Pediatric Clinics

of North America, 47(5): 1177-1189.10 MacKay AP, Fingerhut LA, & Duran CR., Adolescent Health Chartbook, National Center for Health Statistics,

Hyattsville, Maryland, 2000.11 Missouri Department of Health, Missouri Information for Community Assessment (MICA), Preventable

Hospitalization Statistics, 1997; Emergency Room Statistics, 1997, Available at:

http://www.health.state.mo.us/BobPrevHosp/aller.html; http://www.health.state.mo.us/BobER/aller1.html.12 Department of Health and Human Services (DHHS, Healthy People 2000, Washington D.C.: U.S.

Governmental Printing Office. Publication No. DHHS-PHS-91-50212.13 McCunniff, M. et al., Evaluation of the Missouri Dental Medicaid Program Missouri Department of Health,

Bureau of Dental Health, Jefferson City, MO, 2005.14

Missouri Head Start, 1999 Missouri Head Start Dental Survey, presented at the Missouri Coalition for Oral Health

Access Policy Forum, February 10, 2000, Jefferson City, MO.15 Citizens for Missouri's Children conducted telephone surveys in February 2000 of St. Louis area dentists (St.

Louis City and County) using lists generated by the Medical Service Recipient Services Office. Seven

dentists on the state list were unreachable by phone.16 Missouri Head Start.17State of Missouri Division of Medical Services Budget Book, 296. 2006.18 Missouri Revised State statutes: RSMo 208.152, 208.166

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