Access to Dental Care

• Borchgrevink A, Snyder A, Gehshan S. 2008. Increasing access to dental care in Medicaid: Does raising provider rates work? Oakland, CA: California HealthCare Foundation.
  

• Borchgrevink A, Snyder A, Gehshan S. 2008. The effects of Medicaid reimbursement rates on access to dental care. Portland, ME: National Academy for State Health Policy.

• Crall J, Schneider D, with American Dental Association (ed.). 2004. Increasing access to Medicaid dental services for children through collaborative partnerships.
  This brief discusses barriers to access to oral health services for children enrolled in Medicaid and presents a rationale for increasing access through collaborative partnerships. The brief identifies three areas of concern associated with Medicaid dental programs that discourage dentist participation and limit access to care. Also provided are examples from several states that have engaged in significant efforts to improve access to oral health services for individuals covered by Medicaid.

• Crall J, Schneider D, with American Dental Association (ed.). 2004. Medicaid program administration.
  This brief discusses the way Medicaid dental programs are administered and how simplifying administrative procedures could help increase access to oral health care for Medicaid enrollees. The brief focuses on how states administer Medicaid dental programs. Topics include single-vendor contracting, state reconsideration of managed care strategies, and state efforts to reduce administrative burdens. Single-vendor programs in Michigan and Tennessee are described. A list of notable Medicaid dental program administrative innovations is also included.

• Crall J, Schneider D, with American Dental Association (ed.). 2004. Medicaid reimbursement: Using marketplace principles to increase access to dental services.
  This brief discusses Medicaid reimbursement rates for oral health services and how these rates, which often fall well below dentists’ fees, contribute to dentists’ reluctance to participate in Medicaid. Topics include problems with current state Medicaid reimbursement rates; using percentile analysis to establish market-based Medicaid reimbursement rates; and state-by-state, regional, and national comparisons of Medicaid payment rates and market-based fees.

• Schneider D, Rossetti J, Crall, J. 2007. Assuring comprehensive dental services in Medicaid and Head Start programs: Planning and implementation considerations. Los Angeles, CA: National Oral Health Policy Center.
  
  

CHIPRA Dental Legislation

• Booth M, Edelstein B. 2009. CHIP reauthorization: Renewed support for children's oral health. Washington, DC: Children's Dental Health Project.
  
  
• Kaiser Commission on Medicaid and the Uninsured. 2010. Children's oral health benefits. Washington, DC: Kaiser Commission on Medicaid and the Uninsured.
  
  
• Sullivan J. 2009. CHIPRA 101: Overview of the CHIP reauthorization legislation. Washington, DC: Families USA.
  
  

CMS and Medicaid

• EPSDT CMS-Form-416 published state and national data
  
  
• Form 416 and Instructions
  
  
• Medicaid Dental Expenditures Compared to Total Medicaid Expenditures, 2005 (Data from CMS-64 forms).
  
  
• Medicaid and SCHIP Quality Spring Teleconference
  On April 3, 2008, the CMS Center for Medicaid & State Operations, Division of Quality, Evaluations and Health Outcomes, conducted a national audio-conference on pediatric oral health. There were presentations on innovative payment practices, state approaches to increasing provider participation and access to dental services, and state approaches to dental performance/quality-improvement measures. Click here for handout materials from the conference.

• Schneider D, Hayes K, Crall J. 2005. The CMS Form-416 report: Understanding its use in assessing dental care utilization in Medicaid's Early Periodic Screening, Diagnostic and Treatment (EPSDT) Service for children. National Oral Health Policy Center.
  This technical issue brief provides an overview of Medicaid and the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program; Medicaid-eligible children's ability to access oral health services; data on children's utlization of oral health services in Medicaid; and the Centers for Medicare and Medicaid (CMS) Services Form-416 report, which is the most common source of such data. The brief provides background on EPSDT and discusses EPSDT statutory enhancements, reporting of EPSDT oral health services utilization (CMS Form-416), rates of oral health services utilization derived from revised CMS Form-416 data, uses of EPSDT oral health utilization data, cautions in using Form-416 data and derived utilization rates, and proposals for additional adjustments to Form-416 data.
  
  
• U.S. Centers for Medicare and Medicaid Services. 2004. Guide to children's dental care in Medicaid. Baltimore, MD: U.S. Centers for Medicare and Medicaid Services.
  
  
• U.S. Centers for Medicare and Medicaid Services. 2009. Town hall forum on access to dental care for Medicaid-eligible children. Baltimore, MD: U.S. Centers for Medicare and Medicaid Services.

• U.S. Department of Health and Human Services, Office of Inspector General. 2007. Improper payments for Medicaid pediatric dental services. Washington, DC: U.S. Department of Health and Human Services, Office of Inspector General.
  
  

Congressional Testimony

• One Year Later: Medicaid’s Response to Systemic Problems Revealed by the Death of Deamonte Driver. Testimony before the U.S. Congressional Committee on Oversight and Government Reform, Subcommittee on Domestic Policy: Tuesday, February 14, 2008.
  
  
• Concerns Remain about Sufficiency of Data for Oversight of Children's Dental Services—Testimony Before the Subcommittee on Domestic Policy, Committee on Oversight and Government Reform, House of Representatives—GAO Report # GAO-07-826T
• Highlights
• Entire report
  
  
• Insuring Bright Futures: Improving Access to Dental Care and Providing a Healthy Start for Children. Testimony before the U.S. House of Representatives, Committee on Energy and Commerce, Subcommittee on Health; March 27, 2007.
  Archived video Webcast of hearing available at http://boss.streamos.com/download/energycommerce/032707.he.hrg.dental.wmv.
  • Jack M. Chapman, M.D., President, Health Access Initiative
  • Christine Farrell, R.D.H., M.P.A., Medicaid Policy Specialist, Medical Services Administration, Michigan Department of Community Health
  • Stephen Corbin, D.D.S., M.P.H., Senior Vice President for Constituent Services and Support, Special Olympics International
  • Burton L. Edelstein, D.D.S., M.P.H., Board Chair, Children’s Dental Health Project, Washington, DC, Professor of Dentistry and Health Policy, Columbia University
  • Chris Koyanagi, Policy Director, Bazelon Center for Mental Health Law
  • David M. Krol, M.D., M.P.H., F.A.A.P., Chair, Department of Pediatrics, University of Toledo College of Medicine
  • Nicholas G. Mosca, D.D.S., University of Mississippi, School of Dentistry
  • Kathleen Roth, D.D.S., President, American Dental Association
  • Raymond C. Scheppach, Ph.D., Executive Director, National Governors Association

• Oversight Adequacy of the Pediatric Dental Program for Medicaid Eligible Children. Testimony before the U.S. House of Representatives, Committee on Oversight and Government Reform, Subcommittee on Domestic Policy; May 2, 2007. Links include:
  • Chairman Kucinich's opening statement and testimony from Frederick Clark, Dennis Smith, Norman Tinanoff, Allen Finkelstein, Jane Perkins, Susan Tucker, Laurie Norris, and James Cosgrove.
  • Video of the hearing.
    
    

EPSDT

• Submit your state's schedule
  
  
• MSDA letter to state Medicaid directors
  This letter was developed by the board of MSDA, in response to a letter that AAPD sent to state Medicaid directors regarding EPSDT and the dental periodicity schedule.

• Schneider D, Crall J. 2005. EPSDT periodicity schedules and their relation to pediatric oral health standards in Head Start and Early Head Start. Los Angeles, CA: National Oral Health Policy Center.
  This technical brief discusses the relationship between Early Head Start (EHS) and Head Start (HS) and EPSDT. The brief, which includes an executive summary, discusses (1) oral health services in HS and EHS programs, (2) the role of Medicaid and its relationship to HS, (3) EHS/HS performance standards for oral health services, (4) linkages to EPSDT and the need for suitable dental periodicity schedules, and (5) periodicity considerations for EHS/HS oral health services. Strategic recommendations are included.
  
  

Health-Care Reform

• Children's Dental Health Project Healthcare Reform Center
  
  
• HealthReform.gov
  
  

State Information

• State survey of American Dental Association claim form use. 2007.
  
  
• Medicaid dental program reports: Submit your state's report
  
  

State Innovations

• State innovations to improve access to oral health care for low income children: A compendium update. 2005.
  This compendium identifies and summarizes successful state interventions to improve access to oral health services for children enrolled in Medicaid or the State Children’s Health Insurance Program (SCHIP). State summaries are divided into two main sections: (1) Medicaid/SCHIP oral health care for children and (2) state oral health care innovations. Information about each of the interventions is presented in the following categories: (1) administrative policies and procedures; (2) work force resources; (3) education, communication, and patient care facilitation; and (4) financing and reimbursement.
  
  
• Crall J, Schneider D, with American Dental Association (ed.). 2004.Enhancing dental Medicaid outreach and care coordination.
  This brief discusses ways to increase awareness of the importance of oral health and to improve care coordination for Medicaid participants, thereby decreasing the rate of no-show appointments and increasing compliance with oral health instructions. The brief focuses on innovative strategies and approaches that some states are using. Topics include consumer outreach, locating Medicaid dental providers, obtaining oral health screenings and referrals, case management and support services, reducing the number of missed appointments, and coordinating oral health care for young children and pregnant women. Brief case studies of several state programs are presented.
  
  
• Dental Medicaid Reform: Core Principles and Policy
  
  
• Gehshan S, Wyatt M. 2007. Improving Oral Health Care for Young Children. Portland, ME: National Academy for State Health Policy
  
  
• Report on the June 23, 2008, Medicaid Provider Symposium. 2008.
  
  
• Understanding the Impacts of Florida's Medicaid Pre-Paid Dental Pilot