The Full Restoration of Adult Dental Benefits and How it Impacts Pregnant Women and Children
MONICAOCHOA,MPHORALHEALTHADVOCACYCOORDINATORMATERNALANDCHILDHEALTHACCESSCPHENHEALTH INTEGRATIONFORUMFEBRUARY8, 2018
MaternalandChildHealthAccess(MCHA)improvesthehealthoflowincomewomenandfamiliesthroughadvocacy,education,
traininganddirectservices.
FullRestoration
Existing:§ ExamsandX-rays§ Cleanings§ Fluoridetreatments§ Fillings§ RootCanalsinfrontteeth§ Prefabricatedcrowns§ FullDentures§ Denturesrelines
New:
§LaboratoryProcessedCrowns
§RootCanalsinBackteeth
§Partialsdentures
§Partialdentureadjustments,repairsandrelines,
§Periodontics(scalingandrootplanning
OnJanuary1,2018,adultswithfullscopeMedi-Calbecameeligibleforfullrestorationofdentalbenefits.
LettermailedouttoMedi-Cal
beneficiaries
Pregnantwomenandthefullrestoration“Dental benefits will not change for pregnant women or adults in a skilled nursing or intermediate care facility”.
AllpregnantwomenintheMedi-Calprogramareeligibleforthefullyrestoredbenefits.InANYaidcode:
• Fullscope• Restricted• PresumptiveEligibility• Pregnancy-only
ProviderManualSection4- Pregnancy-RelatedServices
EffectiveOctober1,2014,pregnantbeneficiaries,regardlessofage,aidcode,and/orscopeofbenefitswillbeeligibletoreceivealldentalprocedureslistedintheDenti-CalManualofCriteria(MOC)thatarecoveredbytheMedi-CalprogramsolongasallMOCprocedurerequirementsandcriteriaaremet.Beneficiarieswillalsobeeligibletoreceivetheseservicesfor60dayspostpartum,includinganyremainingdaysinthemonthinwhichthe60thdayfalls.
BenefitsQuick
ReferenceGuide
Thischartconveysthefullrestorationinasimpleandstraightforwardmanner
The 2013 utilization rate for Los Angeles County is 14.6 for pregnant women who received a pregnancy related medical service and a pregnancy related dental service.
Wedonothavecomprehensiveutilizationdataforpregnancy
Wecanonlyobtaindatafrompregnancyonlyaidcodes
Welackdatafromnon-pregnancyaidcodes
Informationfromwomenwhovisitthedentistduringtheirpregnancyisnotquantified(notcapturedontheclaimform)
Howmanypregnantwomenactuallyvisitthedentistwhatthedatatellsus…andwhat'smissing
PregnancyisaTeachableMomentWhat happens when a woman accesses dental care (and now the fully restored benefits) during pregnancy?
• Resultsinahealthierpregnancy• Bettermaternal-childoutcomes• Lowerstheoraldiseasethatcanbetransmittedfrommothertochild
• Reducesearlychildhoodcaries• Momstartstovieworalhealthasanintegralpartofoverallhealth
• Shebeginstotakeontheroleofamaincare-giver
Impactonthefamily• Vieworalhealthasanintegralpartofoverallhealth
• Decisionmakers• Ensurethattheirchildrenmisslessschooldaysduetodentalpain
• Arethecenteroftheirimmediateandextendedfamilyandcaninfluencethemondentalutilization
• Whenamomvaluesoralhealth,shepassesthatimportanceontoherkidsandfamily
IntegrationandMultipleEngagementPoints
Families need numerous reminders from different agencies; • Eligibility or social worker, • Primary care providers, schools, • Home visitors, • Faith-based organizations, • WIC offices, • At health fairs • etc…
MCHAoralhealthprogrammaticandpolicyworkMCHAhasbeenincreasingaccesstooralhealthresourcesandutilizationthrough
• Casemanagement
• Medi-Calenrollment
• Grantsandfundingfororalhealthadvocacywork
• Homevisitationprogramstoaskaboutdentalcareandprovideresources
• Trainingaboutdentalbenefitsandpolicies
• Policyandadvocacyworkatthestateleveltoincreaseaccesstocareforpregnantwomen
• HostandconvenetheLAStakeholdermeetingswithDHCS
WelcomeBaby- largesthomevisitationpilotprojectinLosAngeles
Whenthepilotwasintheinitialplanningphases,MCHAadvocatedfordentalquestionstobeapartoftheintake.
WB2017PrenatalIntake-DentalQuestionsDentalInsurance Number PercentDenti-Cal 659 96%PrivateDentalCoverage 18 3%NoDentalInsurance 7 1%
AtIntake:DentalExaminpast12months? Number PercentYes 321 47%No 365 53%TotalPrenatalEnrollments 686 100%
Resources•MCHAwebsite– www.mchaccess.org
•https://www.cdafoundation.org/portals/0/pdfs/poh_guidelines.pdf
OralHealthDuringPregnancyandEarlyChildhoodGuidelines
•https://www.mchoralhealth.org/
NationalMaternalandChild
OralHealthResourceCenter
Educateothersandadvocate,attendstakeholdermeetings,documentgapsandbarrierstocare
Questions and contact informationMonicaOchoa,MPH
OralHealthAdvocacyCoordinatorMaternalandChildHealthAccess1111WestSixthStreet,FourthFl.
LosAngeles,CA90017213– 749-4261
