Policy changes could give kids on Medicaid reason to smile more

By Elizabeth Hillaker Downs, University of Florida
Headline Goes Here Mindy Miller/University of Florida

Lindsay Thompson, associate director of clinical research for the Institute for Child Health Policy and a UF Health pediatrician, administers an oral health screening. 

GAINESVILLE, Fla. - Children on Medicaid and their parents may have a reason to smile more: A study by University of Florida researchers shows that a change in the state of Florida's Medicaid policy to reimburse pediatricians and other medical primary care providers for basic oral-health screenings and cavity prevention has increased the likelihood of children receiving these essential services by 20 percent.

This is particularly important in Florida because the state is ranked 50th in the nation in dental care rates among children enrolled in Medicaid. Untreated tooth decay, which occurs in 25 percent of children living in poverty, can lead to pain, difficulty eating, serious infections, missed school days, emergency room visits, hospitalizations and, in rare instances, death.

"Given the high stakes for untreated tooth decay on children's overall health and well-being, especially among vulnerable and low-income children, it is important to identify effective policies to tackle this prevalent problem," said Jill Boylston Herndon, an associate professor in the department of health outcomes and policy in the UF College of Medicine and the lead researcher on this National Institutes of Health-funded project. "Particularly among very young children, medical primary care providers serve as the gateway to the health care system and can play an important role in preventing tooth decay and facilitating the establishment of a dental home."

Only 31 percent of publicly insured children under age 5 receive dental services nationwide.

Although comprehensive dental benefits are required in Medicaid, it is much more likely that preschool-age children enrolled in Medicaid will receive medical care than dental care.

Therefore, 46 state Medicaid programs, including Florida, have enacted policies since 2000 to reimburse medical primary care providers to administer early childhood tooth decay preventive services . These services may include topical fluoride application, parental counseling, mouth exams and an overall assessment for risk of tooth decay.

The policy in Florida, which covers children ages 6 months to 42 months and was implemented on April 15, 2008, reimburses providers $27 for these services. Topical fluoride application, combined with parental counseling, has been shown to reduce tooth decay by up to 50 percent in high-risk children.

"We are fully committed to increasing the number of Medicaid-enrolled children who receive preventive dental services," said Beth Kidder, assistant deputy secretary for Medicaid Operations at the Agency for Health Care Administration in Tallahassee. "We are pleased that our policy change is expanding good oral health care to more children."

The researchers examined reimbursement data on more than 1 million children in Florida and almost 2.1 million children in Texas, which enacted a similar policy, for a total sample size of more than 3.1 million.

In total, there was a 130 percent increase in services such as oral health screenings and topical fluoride applications for children between the ages of 6 months and 42 months in Florida.

Even after controlling for factors that could influence the findings, such as age and length of Medicaid enrollment, children covered under the policy were 20 percent more likely to receive oral health preventive services than before the policy was enacted when compared with another group of children who were too old to be covered under this specific policy.

This analysis, which was published in the journal Health Services Research in July, has far-reaching public health implications given that Medicaid covers more than one-third of all children in the U.S.

Led by Herndon, the multidisciplinary team that completed the analysis included W. Bruce Vogel and Elizabeth A. Shenkman of the department of health outcomes and policy in the UF College of Medicine, as well as Scott L. Tomar and Frank Catalanotto of the department of community dentistry and behavioral science in the UF College of Dentistry.

"As primary care providers, we are the medical home base for parents and children, so providing oral health services should be prioritized. Now, with reimbursement, they are," said Lindsay Thompson, the associate director of clinical research for the Institute for Child Health Policy and a UF Health pediatrician who has provided oral health services to children since 2006. "These oral health services are not difficult to administer and they can have such a profound effect -- not only on the children's oral and overall health, but also on convincing parents of the importance of oral care." 

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