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Assuring Comprehensive Dental Services in Medicaid and Head Start Programs |
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UCLA Center for Healthier Children, Families and Communities As part of efforts to improve access to required dental services for their child beneficiaries, state Medicaid agencies and Head Start programs recently have considered models or arrangements that include a limited set of services---usually dental screening and/or prevention services---often provided by non-dentists outside of 'traditional' dental care delivery settings. Dental caries (tooth decay) is the most common chronic disease among children, with economically disadvantaged children and ethnic minority children experiencing the highest rates of disease.1-3 Recent national survey data show that 28% of all two-to-five-year-old U.S. children exhibit evidence of tooth decay, up from 24% ten years previously.3 However, statistics such as these -- which reflect average caries prevalence across multiple age groups -- mask the progressive nature of dental caries and obscure the fact that the prevalence of tooth decay in children generally increases with age. The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) provisions of Medicaid statutes and regulations constitute a common foundation of program/policy requirements for both Medicaid and Head Start.16 Over the past decade, Medicaid and Head Start programs have sought to enhance their enrollees' access to early, ongoing, appropriate, comprehensive dental services. However, progress in achieving improved access has been slow and hindered by long-standing barriers that discourage dentists' participation in Medicaid. Medicaid policy requires direct referrals of enrolled children to dental providers for comprehensive diagnostic, preventive and treatment services.24 State Medicaid policies usually specify that dental referrals begin by at least age 3, and before age 3 in many states. However, children's initial contacts with the health care delivery system generally occur in physicians' offices. The primary motivation for considering alternative dental delivery models is to increase access to providers who are willing and able to meet the needs of Medicaid beneficiaries and Head Start enrollees.
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