Pennsylvania Medical Assistance : Evaluation of Children ’ s Access to Dental Services
• Pennsylvania increased the types of Medical Assistancecovered dental providers . In 2010 , the Pennsylvania General Assembly passed legislation to expand the duties of expanded function dental assistants ( EFDAs ). 32 The expanded function dental assistants can now perform coronal polishing , apply fluoride varnish , and take impressions of teeth for athletic appliances . Currently , Medical Assistance does not directly reimburse expanded function dental assistants for services , but it reimburses the supervising dentist for dental services provided by expanded function dental assistants .
• On April 1 , 2010 , Medical Assistance began to reimburse enrolled physicians and certified registered nurse practitioners for the application of topical fluoride varnish for eligible children . 33 However , although children of all ages can benefit from fluoride varnish , Medical Assistance restricts the application of fluoride varnish by physicians and certified registered nurse practitioners to children from birth through four years of age .
• In 2010 , the state added a dental-related measure to the pay-for-performance program .
We cannot assess the impact of these policies on Medical Assistance children ’ s use of dental services , although we suspect that the impact of these changes is positive . We note that there was a significant increase in annual dental visits among all children aged 4-21 covered by Medical Assistance FFS and MCOs .
Options to Consider for Improving Dental Care for Children Under Medical Assistance
Pennsylvania has a shortage of Medical Assistance dentists , especially in rural areas . This deficit could be addressed in part by making greater use of other medical providers . Children in Pennsylvania see primary medical care providers such as pediatricians , physicians , nurse practitioners , physician assistants , and nurses for checkups and evaluations for school . It is generally understood that the primary care setting may be an ideal place to deliver preventive dental services , such as an oral health assessment , fluoride varnish and parental education , for children enrolled in Pennsylvania Medical Assistance . As a result , many state Medicaid programs are reimbursing physicians , certified registered nurse practitioners or physician assistants for dental services . North Carolina ’ s Into the Mouth of Babes , a preventive dentistry program that targets children from birth to three years of age , 34 utilizes pediatricians , family physicians , nurse practitioners , nurses , physician assistants and other public health workers in community health clinics to provide dental services to Medicaid children . After successfully completing a training period , providers are eligible to bill Medicaid up to six visits for oral care provided during the first three years of a child ’ s life . 35 The covered dental services include : risk assessment , oral screening , prevention services such as fluoride application and education for parents and children . 36 Pennsylvania has taken a step in this direction with its current policy to reimburse enrolled physicians and certified registered nurse practitioners for the application of fluoride varnish to children aged zero through four . Pennsylvania could go even further by directly reimbursing other medical providers to expand the availability of dental care for Medical Assistance children , similar to the North Carolina medical model . Another approach is the state of Washington ’ s Access to Baby and Child Dentistry ( ABCD ) program . ABCD works to : enroll Medicaid-eligible children by age one ; educate families about dental hygiene and eating habits ; provide outreach and case management ; train dentists in best care practices for young children ; and create referral networks of pediatric dentists for children with more difficult treatment needs . 37 From 1997 to 2008 , the number of Medicaid children under age six who received annual dental care more than doubled because of ABCD . 38 Pennsylvania could consider a pilot program similar to ABCD to improve children ’ s dental health . We acknowledge a final option is to continue increasing dental fees to reach the national Medicaid average of 60.5 percent of retail fees . 39 However , budget constraints may cause this to be impossible in the current fiscal and political climate .
Conclusion
About one-third of the children in the Commonwealth receive dental care services through the Medical Assistance program . Although the proportion of Medical Assistance children that had an annual dentist visit has increased markedly overtime , but is still low by national standards . According to the Kaiser Family Foundation , about 60 percent of children covered by public insurance had an annual dental visit . 40 An important factor influencing access to care is dental provider participation in Medical Assistance . We estimated that only 26 percent of Pennsylvania ’ s practicing dentists treated and billed for at
24 September / October 2010 • Pennsylvania Dental Journal