AAPD evaluates oral health services offered under Medicaid
In the March issue of The Journal of the American Dental Association (JADA), investigators from the American Academy of Pediatric Dentistry (AAPD) present a study titled, “State Medicaid Early and Periodic Screening, Diagnosis, and Treatment Guidelines: Adherence to Professionally Recommended Best Oral Health Practices.” The report is the first to provide an assessment of each state’s compliance with recommended best practices for infants and toddlers as defined by state EPSDT schedules, reflected in services offered under Medicaid.
CHICAGO — March 4, 2013 — In the March issue of The Journal of the American Dental Association (JADA), investigators from the American Academy of Pediatric Dentistry (AAPD), the leading authority on children’s oral health, present a study titled, “State Medicaid Early and Periodic Screening, Diagnosis, and Treatment Guidelines: Adherence to Professionally Recommended Best Oral Health Practices.” The report is the first to provide an assessment of each state’s compliance with recommended best practices for infants and toddlers as defined by state EPSDT schedules, reflected in services offered under Medicaid. The study’s primary author, Dr. Jacqueline Hom, PhD student and pediatric dentistry resident, University of North Carolina at Chapel Hill, completed the manuscript as part of her project as the AAPD’s Samuel D. Harris Research and Policy Fellow.
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Since 1991, the AAPD has offered detailed recommendations for professional pediatric oral health services, including guidelines for the frequency and content of dental visits. These recommendations begin at birth and include the content and timing of developmental assessments, clinical examinations, and diagnostic tests. Due to the wide acceptance and endorsement of these recommendations, the AAPD guideline is the benchmark for professional guidelines on children’s dental periodicity schedules.
Medicaid is the largest public health insurance program for low-income Americans and it finances health-care coverage for almost 60 million people, one-third of whom are children. Early and Periodic Screening, Diagnosis, and Treatment Guidelines (EPSDT) helps ensure that low-income children covered by Medicaid have access to comprehensive and periodic evaluations to target health conditions and problems for which growing children are at risk.
As a joint federal and state program, Medicaid is operated by the states within broad federal requirements. Medicaid programs differ substantially from state to state. (1) Although adult dental benefits are optional, all states are federally mandated under EPSDT to cover comprehensive dental services for children under 21 years of age.
Under federal law, schedules specifying the content and periodicity of dental services under EPSDT must be established by each state after consultation with recognized dental organizations involved in child health care. Though all 50 states and the District of Columbia had a dental component to their EPSDT guidelines, 33 or 65% had separate dental EPSDT periodicity schedules and the ones that did included over 85% of recommended best oral health practices. Overall, states with separate dental periodicity schedules were more adherent to best oral health practices than states without separate dental periodicity schedules. Among states with separate dental EPSDT periodicity schedules, the following ten states were optimally consistent with best practice guidelines for periodicity and content: California, Georgia, Idaho, Iowa, Massachusetts, Pennsylvania, Rhode Island, Texas, Utah, and Vermont.
“We are encouraged by the fact that the majority of the states had adhered to professional recommendations for the age one dental visit,” stated Dr. Jessica Y. Lee, who served as faculty mentor for the project and is the Graduate Program Director, Department of Pediatric Dentistry, at the University of North Carolina’s School of Dentistry, as well as national spokesperson for the AAPD.
Pediatric dentists are committed to the care of Medicaid- and Children’s Health Insurance Program–covered children, who account for about 25% of the typical pediatric dental practice. According to Dr. Paul Casamassimo, director of AAPD’s Pediatric Oral Health Research and Policy Center, “Consistency of policy across the states related to periodicity has the potential to improve access and to develop workable systems for interprofessional care.”
The American Academy of Pediatric Dentistry (AAPD) is the recognized authority on children’s oral health. As advocates for children’s oral health, the AAPD promotes evidence-based policies and clinical guidelines; educates and informs policymakers, parents and guardians, and other health-care professionals; fosters research; and provides continuing professional education for pediatric dentists and general dentists
who treat children. Founded in 1947, the AAPD is a not-for-profit professional membership association representing the specialty of pediatric dentistry. Its 8,400 members provide primary care and comprehensive dental specialty treatments for infants, children, adolescents, and individuals with special health-care needs. For further information, please visit the AAPD website or the AAPD’s consumer website.
1. Oral health: Dental disease is a chronic problem among low-income populations. Washington, DC: United States General Accounting Office; 2000. GAO/HEHS publication 00-72.