Medicaid EPSDT: State Innovation Leads to Improved Oral Health Participation Ra

Executive Summary

A number of states are increasing children's utilization of dental care through the EPSDT program.This paper reports on oral health screening data and briefly summarizes the initiations being carried out in six such states.

A number of states are increasing children's utilization of dental care through the Medicaid Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program. Targeting dental care, these states have implemented innovative programs. This paper reports on oral health screening data and briefly summarizes the initiations being carried out in six such states.
 
A word about methodology
 
The data presented in this paper are based on the states' own reports of participation rates on the CMS Form-416, the uniform EPSDT reporting form. Participation ratios are based on the "total number of eligible children who should have received at least one EPSDT screen" (line 8 of the CMS Form 416) and take into account the average period of eligibility, i.e., the fact that not all children are enrolled with Medicaid for the continuous 12-month period of the fiscal year. Using the average period of eligibility (i.e., line 8 from the Form 416), is the manner in which overall well-child screening EPSDT participation ratios, as defined by the federal State Medicaid Manual, are calculated.
 
The dental participation ratios cited below do not provide any information concerning whether an eligible child has received the number of biannual preventive visits that are recommended by the American Academy of Pediatric Dentistry. According to the instructions for the CMS Form 416, the data from lines 12a and 12b should consist of the unduplicated number of children who have received any dental services and the unduplicated number of children who have received preventive dental services, respectively. Because each child should be "counted" only once each fiscal year for each category, regardless of the number of dental services or preventive dental services they received in one year, these data from lines 12a and 12b do not reflect the total number of dental appointments each child had in any given year.
 
The figures below reflect use by all children birth through age 20 and for four discrete age groups: children age 3 to 5, 6 to 9, 10 to 14, and 15 to 21.
 
Participation ratios for selected states (2004 and 2005)
 
Tables 1 and 2 set forth the total percentage of children who should have received a well-child examination who received any dental services for fiscal years 2004 and 2005, for six states: Alabama, Indiana, North Carolina, South Carolina, Vermont, and Washington.1

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