Reports
Currently, 35 states Medicaid programs pay medical providers for preventive dental care. In North Carolina, a leader in the field, these services reached 60,000 children under age 4 in 2007. By compensating physicians for providing this valuable dental care intervention, states can help reduce the tremendous access barriers low-income children face when trying to obtain much needed oral health care services.
Since the 1980s ASTDD has used the Guidelines for State and Territorial Oral Health Programs to assist health agency officials and public health administrators to develop and operate strong oral health programs. The Guidelines promote integration of oral health activities into public health systems to assure healthy populations and communities for tomorrow.
Today’s Americans face steep challenges in maintaining a healthy family amidst a troubling economy and an inadequate healthcare system. Dental care is often neglected due to lack of access or affordability–resulting in caries becoming the most common chronic disease in children. Families tend to seek emergency care only when oral health problems become too severe, which dramatically increases the costs of care for programs. the health care system to more successfully promote prevention?
While the dental home concept is clearly articulated by organized dentistry and accepted as policy, its widespread adoption and implementation will require consideration of environmental factors that include: (1) the advent of social medicine, (2) expanding knowledge of caries risk and its management; (3) trends in oral health disparities and the demography that drives those disparities; (4) parents’ perceived needs for, and barriers to, dental care; (5) dentistry’s relationship to medicine as a profession; and (6) dental services capacity.
Although children’s dental health in the U.S. has improved over recent decades, a subset of children continues to suffer dental disease severe enough to constitute a public health problem. The Chartbook that follows examines dental health status, use of preventive services, and dental insurance among rural and urban children. The Chartbook provides information specific to rural children, and in particular rural minority children, not available in similar detail from other sources. This information can be used at the state level for program planning and assessment.
On May 25, 2000, Surgeon General David Satcher released Oral Health in America: A Report of the Surgeon General, the 51st Surgeon General’s report issued since 1964, when Luther Terry issued his landmark report on tobacco and health… In addition to a lack of awareness of the importance of oral health among the public, the report found a significant disparity between racial and socioeconomic groups in regards to oral health and ensuing overall health issues.
Healthy People 2020 continues in the tradition of Healthy People 2010 with the launch on December 2, 2010, of its “ambitious, yet achievable, 10-year agenda for improving the Nation’s health.” And “Healthy People 2020 is the result of a multiyear process that reflects input from a diverse group of individuals and organizations.
In addition to a lack of awareness of the importance of oral health among the public, the report found a significant disparity between racial and socioeconomic groups in regards to oral health and ensuing overall health issues. Based upon these findings, the Surgeon General called for action to promote access to oral health care for all Americans, especially the disadvantaged and minority children found to be at greatest risk for severe medical complications resulting from minimal oral care and treatment.
Many oral health grantmakers have become more sharply focused on policy solutions to improve oral health. This transition has occurred, at least in part, because of the inability of more traditional approaches to successfully reduce oral health disparities… The examples provide a snapshot of foundation work in this area.
Strategies to prevent and control early childhood tooth decay should address the dental disease, systems of care that support children during their early developmental years, and public health practices.
Schools cannot – and should not be expected to – solve the nation’s most serious health and social problems…However, schools provide a critical facility in which many agencies might work together to maintain the well-being of young people. CDC developed a research-based model for a Coordinated School Health Program…a planned, organized set of health-related programs, policies, and services coordinated to meet the health and safety needs of K-12 students at both the school district and individual school levels.
…the summary of a three-day workshop, evaluates the sufficiency of the U.S. oral health workforce to consider three key questions: What is the current status of access to oral health services for the U.S. population? What workforce strategies hold promise to improve access to oral health services? How can policy makers, state and federal governments, and oral health care providers and practitioners improve the regulations and structure of the oral health care system to improve access to oral health services?
This State Health Policy Briefing provides an overview of state efforts to increase access to dental care for children through the use of primary care medical providers. The results from a new NASHP survey provide an overview of state programs, which vary in their scope, implementation, and reimbursement policies.
…the National Academy for State Health Policy and the Pew Center on the States conducted a comprehensive literature review and interviews with leading experts in several states to learn about existing proposals for new dental providers. This guide is intended to provide policy makers with objective information and the tools they need as they consider new workforce models. This report explores three proposed provider types: Dental Therapists, Community Dental Health Coordinators, and Advanced Dental Hygiene Practitioners.
This 52 page report explores the interest and need to establish new midlevel dental providers in the U.S. The genesis of this interest is concern about access to care for underserved populations whose higher oral disease rates and unmet oral care needs are well documented. This document was published December 2009 and updated June 2010.
The report examines “the impact that hiring new types of dental providers—dental therapists and hygienists-therapists—could have on both the productivity and profits of a private dental practice, where more than 90 percent of the nation’s dentists work. The study also assesses the impact of a third type of provider, dental hygienists, who are currently employed by most dental practices…The report features an interactive Productivity and Profit Calculator that dentists can use to evaluate the impact of new providers on their individual practices.”
…in 2003 the Alaska Native Tribal Health Consortium (ANTHC), in collaboration with tribal health organizations, began the Alaska Dental Health Aide Initiative to provide dental health aide therapists to rural villages… In January 2008, the W.K.
The American Dental Association “offers this paper addressing one of the major barriers to care: the need for an adequate dental workforce, located where it is needed, and sufficiently funded to carry out its mission."
DentaQuest Foundation created this Compendium to serve professionals building community-based coalitions dedicated to improving oral health. It is one of several initiatives currently under way that respond to the National Call to Action to Promote Oral Health. The citations in this encyclopedic compilation link to free, full-text publications crossing the fields of communication, management practice, oral health, prevention, psychology, public health education, and public policy.
This Statistical Brief presents estimates from the 1996 and 2006 Household Component of the Medical Expenditure Panel Survey (MEPS-HC). Moreover, this Brief provides data on the reported prevalence of dental coverage and the relationship of dental coverage to use for children and young adults age 0−20 living in the U.S. noninstitutionalized (community) population.
Among approximately 172 million persons under age 65 years with private health insurance: The majority of persons (73%) had some type of dental coverage. However, approximately 45 million persons had no dental coverage. About 8 out of 10 persons with employment-based private health insurance had dental coverage compared with about 3 out of 10 persons with directly purchased insurance. Non-Hispanic black persons were more likely to have dental insurance than non-Hispanic white persons, non-Hispanic Asian persons, or Hispanic persons.
This industry report is intended to provide…a better understanding of the dental benefits market, illustrate its relationship to the health benefits market and demonstrate the real value of dental benefits. Data from a number of industry and government sources were cited in completing this summary of the industry.
Parental oral health-seeking behaviors for themselves may have an important effect on oral health-seeking behaviors on behalf of their children, regardless of the child’s insurance status. Comprehensive strategies to eliminate barriers that target parents and not just children may help to address children’s underuse of oral health services.
This report summarizes the results of the 2010 Synopsis of State Dental Programs (2010 Synopsis); which represents the status of the state oral health program during the 2008-2009 fiscal year.
The State Oral Health Policy Comparison Tool was originally developed in 2005-06 to provide an overview of the current state of state oral health plans and to facilitate cross-state comparisons. Over the past four years, states funded through the Centers for Disease Control and Prevention (CDC) State-Based Oral Disease Prevention Program and other states have updated or created new plans. The Comparison Tool captures the most recent information.
CSBA and DHF, with grant support from the Robert Wood Johnson Foundation, developed this guide to empower school board members and administrators to create an effective school-based oral health infrastructure. The guide provides background information, policy development tools and other strategies for addressing students’ oral health needs.
The purpose of the National Maternal and Child Oral Health Resource Center (OHRC) is to respond to the needs of states and communities in addressing current and emerging public oral health issues…The Oral Health Resource Bulletin is a periodic publication designed to stimulate thinking and creativity within the maternal and child health (MCH) community by providing information about selected materials of interest.
This Issue Brief explores “how oral health practices and utilization of dental care among pregnant women may affect a woman’s overall health, her birth outcome, and the oral health of her children.
In February 2009, an expert panel of medical and dental professionals presented a review of scientific literature and recent research to derive practice guidelines based on evidence and professional consensus, which substantiates the relationship between health and oral health status and promotes the importance and safety of dental care during pregnancy. Where possible, the material was adapted, supplemented, updated and rewritten based on the 2006 New York State Department of Health publication, “Oral Health Care During Pregnancy and Early Childhood Practice Guidelines.”
…there is a wide variation among states in the types of dental services and degree of coverage offered under Medicaid. It is important to note that the benefits covered also vary in total amount, duration, and scope of coverage. Six states do not cover any dental…As of early 2008, 45 states, including the District of Columbia, provided some type of coverage of dental benefits to at least some Medicaid-enrolled adults. However, this coverage ranged from comprehensive dental care to coverage limited to emergencies, or coverage for only certain categories of enrollees.
Since the great majority of dental care available in this country is delivered by private dentists, their participation is key to improving access in Medicaid. Dentists cite three primary reasons for their low participation in state Medicaid programs: low reimbursement rates, burdensome administrative requirements, and problematic patient behaviors. In the late 1990s and early 2000s, a number of states took dramatic steps to improve access to dental care in Medicaid.
Dental disease and inadequate receipt of dental care remain significant problems for children in Medicaid. Nationally representative survey data from 1999 through 2004 indicate that about one in three children aged 2 through 18 in Medicaid had untreated tooth decay, and one in nine had untreated decay in three or more teeth. Projecting the survey results to the 2005 average monthly Medicaid enrollment of 20.1 million children, we estimate that 6.5 million children aged 2 through 18 in Medicaid had untreated tooth decay.
Along with state efforts to increase dentists’ participation in Medicaid and the State Children’s Health Insurance Program (SCHIP), hospitals, community health centers, health departments, dental schools and others are working to expand dental services, with some focusing on basic preventive services and others pursuing more comprehensive dental care. Many community efforts rely on increasing the number of dental professionals available to treat low-income people.
This policy briefing, which is drawn from a literature review and interviews with stakeholders across the country, describes strategies that several states have used to better address the oral health needs of these groups by…Enhancing the training of dental professionals…Broadening service delivery sites…Enhancing state contracts… Using existing safety net pathways…”What follows is a brief description of the oral health challenges faced by young children, pregnant women, people with developmental disabilities, and people in rural areas, and the responses of six states to those challenges.
Although it is firmly established that oral health is an integral component of children’s overall health and well-being, a large share of children do not receive recommended preventive and primary oral health care, and oral health care is the most prevalent unmet health care need among children. Difficulties obtaining care disproportionately affect low-income and minority children.
Although all 21 states that provide Medicaid dental services through managed care organizations (MCO) reported that they set measurable access standards for MCOs, 14 states reported that MCOs do not meet all of the state’s dental access standards. Almost all states described initiatives to improve access to dental services, including simplifying claims processing, increasing reimbursement rates, recruiting providers, and educating beneficiaries. Nonetheless, access rates remain low and states reported that long-standing barriers hinder further improvement.
Obtaining dental care for children in Medicaid and CHIP remains a challenge, as many states reported that most dentists in their state treat few or no Medicaid or CHIP patients. And, while HHS’s Insure Kids Now Web site—which provides information on dentists who serve children enrolled in Medicaid and CHIP—has the potential to help families find dentists to treat their children, GAO found problems, such as incomplete and inaccurate information, that limited the Web site’s ability to do so.
Initiated in 1994, the state of Washington’s Access to Baby and Child Dentistry (ABCD) program successfully brings together stakeholders across the oral health field to confront the causes of dental disease among Medicaid-eligible children under age six…communities draw on the expertise and resources of dentists, educators, public health agencies, Medicaid representatives and philanthropic leaders to better inform parents and increase the number of dental offices prepared and willing to care for their children.
The experiences of Iowa, Minnesota, North Carolina, Utah, and Washington demonstrate that reimbursement policies are most successful when they involve a collaborative team of partners and link to broader, multi-pronged efforts to improve children’s oral health. Partners in case study states are committed to meeting the oral health needs of all children; their lessons may be useful in designing policies for other populations, such as children who are in the Children’s Health Insurance Program (CHIP) or are privately insured.
Several states are demonstrating the way forward with proven and promising approaches in four areas: preventive strategies such as school sealant programs and water fluoridation; improvements to state Medicaid programs to increase the number of disadvantaged children receiving services; workforce innovations that can expand the pool of providers; and tracking and analysis of data to measure and drive progress.
Signed into law in February of 2009, the Children’s Health Insurance Program Reauthorization Act (CHIPRA) renewed and strengthened the Children’s Health Insurance Program (CHIP)… The law provided states with new tools and fiscal incentives to enroll eligible uninsured children in Medicaid and CHIP. It also included provisions focused on improving the quality of care and benefits for children. Among these provisions are new requirements and options aimed at improving the oral health of children…
With widespread support from across the child advocacy and oral health communities, Congress ensured that dental care for children was fully integrated throughout the Patient Protection and Affordable Care Act (ACA). The challenge now is to ensure that the numerous oral health provisions are sufficiently supported, implemented, and evaluated so that the promise they hold can be transformed into improved oral health for all.
Schools cannot – and should not be expected to – solve the nation’s most serious health and social problems…However, schools provide a critical facility in which many agencies might work together to maintain the well-being of young people. CDC developed a research-based model for a Coordinated School Health Program…a planned, organized set of health-related programs, policies, and services coordinated to meet the health and safety needs of K-12 students at both the school district and individual school levels.
This report summarizes the results of the 2010 Synopsis of State Dental Programs (2010 Synopsis); which represents the status of the state oral health program during the 2008-2009 fiscal
This Issue Brief explores “how oral health practices and utilization of dental care among pregnant women may affect a woman’s overall health, her birth outcome, and the oral health of her children.
Dental disease and inadequate receipt of dental care remain significant problems for children in Medicaid. Nationally representative survey data from 1999 through 2004 indicate that about one in three children aged 2 through 18 in Medicaid had untreated tooth decay, and one in nine had untreated decay in three or more teeth. Projecting the survey results to the 2005 average monthly Medicaid enrollment of 20.1 million children, we estimate that 6.5 million children aged 2 through 18 in Medicaid had untreated tooth decay.
The experiences of Iowa, Minnesota, North Carolina, Utah, and Washington demonstrate that reimbursement policies are most successful when they involve a collaborative team of partners and link to broader, multi-pronged efforts to improve children’s oral health. Partners in case study states are committed to meeting the oral health needs of all children; their lessons may be useful in designing policies for other populations, such as children who are in the Children’s Health Insurance Program (CHIP) or are privately insured.
