By Colin Reusch, Children’s Dental Health Project
Despite evidence that access to dental care in Medicaid and CHIP is on the rise, tooth decay remains the most common chronic condition among children. And while tooth decay is especially prevalent among children of low-income families, less than half of all children enrolled in Medicaid see a dentist each year. Recognizing the need to improve the current oral health care delivery system, the Children’s Dental Health Project (CDHP) recently released a policy brief outlining strategies for state policymakers to improve children’s oral health and maybe save some money at the same time.
Drawing from system dynamics modeling research, CDHP’s brief examines policy solutions aimed at preventing and managing early childhood caries (ECC), the disease that causes tooth decay. The underlying research tested various interventions and their impact on disease reduction as well as potential cost savings to the New York State Medicaid program over a 10-year period. What the researchers found is that we can significantly reduce the prevalence of tooth decay in young children with some pretty simple approaches like frequent application of fluoride varnish and follow-up care for high-risk children; providing xylitol gum to mothers and caretakers of these same children; and focusing on promoting healthy behaviors through motivational interviewing. Moreover, the research showed reduced costs for restorative care and even net savings when certain interventions were targeted to the populations at highest risk for tooth decay.
The challenge, however, is reconciling the current oral health care system with practices that can improve health outcomes and reduce costs. To that end, CDHP’s policy brief makes a number of policy recommendations that states can adopt so the delivery of care better reflects the evidence. For example, Medicaid programs can adopt periodicity schedules that require an oral health risk assessment and individualized treatment for children at highest risk for developing tooth decay. By better incentivizing adherence to clinical guidelines like those developed by the American Academy of Pediatric Dentistry and American Academy of Pediatrics, public and private insurers alike can ensure that every child gets the care she needs to prevent or arrest ECC.
In addition, states can take advantage of opportunities in the Affordable Care Act (ACA) allowing them to provide the law’s preventive services to all Medicaid beneficiaries at no cost and receive a 1 percent increase in their federal match for these services. The ACA also allows the delegation of preventive services to non-traditional providers which could open the door for community health workers to engage families in improving oral health at home and identify high-risk children earlier.
We all recognize that state budgets are tight, but a little innovation stands to go a long way. CDHP’s latest document provides policymakers with realistic and cost-effective approaches to further reduce the prevalence of tooth decay. By engaging non-dental providers and targeting interventions to each child’s level of risk for disease, states can significantly improve the health of children and families as well as their own bottom line.
