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Oral Health Outcomes. Alabama Medicaid’s impact on Oral Health Stephen Mitchell, DMD, MS Director of Predoctoral Pediatric Dentistry. Overview. Impact of Oral Health Medicaid’s Dental Program History Current Status Other State’s Track Record Oral Health Outside of Dentistry.

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Oral health outcomes

Oral Health Outcomes

Alabama Medicaid’s impact on Oral Health

Stephen Mitchell, DMD, MS

Director of Predoctoral Pediatric Dentistry


Overview
Overview

  • Impact of Oral Health

  • Medicaid’s Dental Program

    • History

    • Current Status

    • Other State’s Track Record

  • Oral Health Outside of Dentistry


Impact of oral health who
Impact of Oral Health: Who

  • 22.9% of school age children have untreated cavities.

    Untreated Dental Caries (Cavities) in Children Ages 2-19, United States CDC

  • Lower socio-economic/Low maternal education 32x more likely to have decay by three years of age


Impact of oral health who1
Impact of Oral Health: Who

  • 32.7% of children from families below 200% poverty level

  • 15% of children above 200% poverty

    Untreated Dental Caries (Cavities) in Children Ages 2-19, United States CDC


Impact of oral health who2
Impact of Oral Health: Who

  • 33% of black school age children.

  • 30% of Hispanic school age children

  • 20% of white school age children

    Untreated Dental Caries (Cavities) in Children Ages 2-19, United States CDC


Impact of oral health who3
Impact of Oral Health: Who

  • >40% of American children have tooth decay by the time they start kindergarten


Impact of oral health what
Impact of Oral Health: What

  • HRSA reports missed class time:

    • ~51 million school hours/year

    • 1,611,000 school days…in 1996

    • Children from poor families missed 12x more

HRSA: Oral Health and Learning

When Children’s Oral Health Suffers, So Does Their Ability to Learn


Impact of oral health what1
Impact of Oral Health: What

  • HRSA reports dental pain impacts behavior:

    • Difficulty paying attention

    • Anxiety

    • Fatigue—dental pain often worse at night

    • Depression

    • Withdrawal from normal activities


Impact of oral health what2
Impact of Oral Health: WhAt

  • HRSA reports when dental disease is treated:

    • Learning improves

    • School attendance improves


Dental program history
Dental Program: History

  • In 2000, Alabama Smile! reform implemented

  • Close collaboration between public and private sector developed

  • Providers increased from 430 in 1997 to 778 in 2007

  • % of children receiving care increased from 25.2% (1997) to 47% (2012)


Dental program history1
Dental Program: History

  • State dental program honored as model program by:

    • ADA

    • AAPD

    • CMS

    • US Congress


Dental program current status
Dental Program: Current Status

  • 47% of Medicaid eligible children in Alabama receive dental care

  • Over past 12 years, preventive services have increase and restorative services decreased

  • Dental represents 1.4% of Medicaid budget (3.5% of budget for 0-21y)


Dental program current status1
Dental Program: Current Status

  • Only 3% operational overhead

    • Cost control can only come from:

      • Decreasing payment

      • Decreasing access

  • Dental carved out of Medicaid restructure

    • Will be reassessed in 2015


Dental program other states
Dental Program: Other States

  • Connecticut:

    • Low reimbursement led to low dentist participation

    • Law suit forced higher reimbursement

  • State with multiple providers:

    • Decrease in providers

    • Decrease in access


If dental joins reform
If dental joins reform

  • Must have one dental RCO for state

  • Must maintain or expand # of unique providers

  • Must maintain or expand # of participants


Oral health outside of dentistry
Oral health Outside of Dentistry

  • 1st Look Program—Infant Oral Health

    • Pediatricians being paid for oral exams and placement of fluoride varnish for patient under three years of age

    • RCOs must protect this program

    • Proposed metric: Maintain or increase # of times fluoride varnish medical code is filed per year


Oral health outside of dentistry1
Oral Health Outside of Dentistry

  • Referrals to establish dental home for high risk patients:

    • AAP policy statement:“Infants identified as having significant risk of caries…should be entered into an aggressive anticipatory guidance and intervention program provided by a dentist between 6 and 12 months of age.”

    • Proposed Metric: Increase the number of referrals of high risk patient to a dental home


Oral health outside of dentistry2
Oral Health Outside of Dentistry

  • Operating Room Access:

    • Currently, access is declining

    • Children under 5 with severe early childhood caries and special needs individuals must have access to OR for dental care in each region

    • Issue: Anesthesia reimbursement


Oral health outside of dentistry3
Oral Health Outside of Dentistry

  • Operating Room Access:

    • Proposed metric:

      • Ideal: Average wait time for dental OR cases under three months (current at UAB >6m)

      • Acceptable: # of dental OR cases maintained or expanded


Available epsdt data
Available EPSDT Data

  • Receiving any dental service

  • Receiving any preventive dental service

  • Receiving dental treatment services

  • Total eligibles receiving a sealant on a permanent molar

  • Total eligibles receiving oral health services by a non-dentist

  • Total eligibles receiving any dental or oral service



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