For example, the ADA’s Council on Dental Benefit Programs has developed a sample template for working with states that contract with third-party administrators of managed care plans. Working alongside other stakeholders, the ADA is engaging state dental associations and Medicaid programs to address these concerns. Need to educate this patient group about the benefits of regular oral care.Issues of cultural competency, including language barriers. Transportation challenges that patients may face.Lack of clear information about existing dental benefits.Perception that no-show rates will be high.Worries about complying with Medicaid regulations.Many dentists are reluctant to treat Medicaid patients, citing these concerns: Kaiser Family Foundation report: improving access to care for adults in MedicaidĬenter for Health Care Strategies report: what’s keeping state oral health leaders up at nightĬenter for Health Care Strategies report: engaging stakeholders to improve access to care for Medicaid-enrolled adults Success story: Take 5 program in Colorado Others accept a modest number of these patients, encouraged by “Take Five” programs that have proven useful in several states. Some dental professionals provide care for large numbers of Medicaid-eligible adults. Many of these individuals urgently need dental care – and with the number of privately insured patients shrinking, some dentists find that treating Medicaid patients isn’t an option, but a necessity to keep their practices going. Cutting Medicaid dental benefits may be a symbolic cost-reduction mechanism for many states, yet it clearly harms those who need preventive dental care the most.Īccording to the ADA Health Policy Institute (HPI), Medicaid-eligible adults represent a growing share of the U.S. Allocation of state Medicaid dollars for dental services averages about 2% of the total Medicaid budget. Making connections: strategies for strengthening care coordination in the Medicaid benefit for children & adolescentsĮven though oral health is crucial to overall health, Medicaid programs often treat dental care as an elective option. Paving the road to good health: strategies for increasing Medicaid adolescent well-care visits Keep kids smiling: promoting oral health through the Medicaid benefit for children & adolescents Insure Kids Now: a website devoted to expanding children’s access to care through Medicaidįrom the American Academy of Pediatric Dentists: state dental periodicity schedulesĮPSDT guide for states: coverage in the Medicaid benefit for children and adolescents Medicaid EPSDT benefit keeps children healthy (PDF) Overview: Early and periodic screening, diagnosis and treatment Here are helpful resources on children’s dental care from, the Centers for Medicare and Medicaid Services (CMS) and other organizations. The ADA supports ongoing efforts to ensure that EPSDT-eligible patients receive the comprehensive care they need. Since we know the value of early, family-centered care in reducing the lifetime incidence of tooth decay, this is a serious concern. Yet even with these goals in place, only around 45% of eligible children actually see a dentist. To control, correct or reduce health issues uncovered by testing.To perform diagnostic tests when risks are identified.To provide screening tests to detect potential problems.To check children's health at periodic, age-appropriate intervals.This benefit is key to ensuring that children and adolescents receive appropriate medical and dental care. The EPSDT benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. Balancing these competing priorities creates an ever-present tension that ultimately affects Medicaid and CHIP.įrom the Kaiser Family Foundation: facts about Medicaid financing, access and more States are required to balance their budgets on a regular basis, making choices about program spending and how much revenue to collect. As a result of this joint financing structure, Medicaid acts as both an expenditure and the largest source of federal revenue in state budgets. As the third largest domestic program in the federal budget - right behind Medicare and Social Security - the program plays a unique role in state budgets. Medicaid is jointly funded by states and the federal government. and is the primary source of funding for states to address the health needs of low-income residents. Medicaid represents $1 out of every $6 spent on health care in the U.S. As of 2021, there are nearly 76 million individuals enrolled in Medicaid. Medicaid provides health coverage to millions of low-income Americans, including eligible adults, children, pregnant women, elderly adults and people with disabilities.
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