Florida Medicaid Policy Improving Oral Health

***UPDATED: January 10, 2015*** A federal judge has ruled that the 1.9 million children enrolled in the Florida Medicaid program for medical and dental care are not receiving the care that is required by federal law, according to a recent Dr.Bicuspid.com article. The 153-page report released by Judge Adalberto Jordan states that 79% of the kids enrolled are getting no dental services at all, even though the law states that they are required to receive preventative medical care. The class action case was filed a decade ago by the Florida Academy of Pediatric Dentistry and the Florida Chapter of the American Academy of Pediatrics. The report claims that serious shortages of specialist care for Medicaid participants might be to blame, and that “children on Medicaid have to travel to other areas of the state and/or wait for several months to obtain care.” Jordan also agreed with plaintiffs that the low reimbursements for doctors and dentists treating Medicaid patients is “by far the most important factor.” He further stated that “a sufficient increase in reimbursement rates will lead to a substantial increase in provider participation and a corresponding increase in access to care.” An additional hearing is planned to determine a course of action in resolving the issue, with an increase in Medicaid rates expected.

Did you know that 25% of American children, ages 2-5 years old, suffer from tooth decay? And the percentage increases (to about 50%) in kids ages 12-15, with the majority of affected young ones falling in a lower socio-economic demographic. Risks of leaving tooth decay untreated include pain, difficulty eating, serious infections, emergency room visits, missed school days, hospitalizations, and in very extreme cases, even death. Unfortunately, the state of Florida is ranked 50th in the country in terms of dental care rates among children enrolled in Medicaid. That means that the Sunshine State is the worst state in America for providing oral health treatments to theses kiddos. While that statistic is less than “sunny,” big changes are happening in Florida that will hopefully improve our standings.

A  Medicaid policy that reimburses pediatricians and other medical primary care providers for basic oral health screenings and preventative treatments, has recently been shown to be effective. A study conducted at the University of Florida analyzed the data to determine if the policy, which went into effect in 2008, was proving to be positive. According to Jill Boylston Herndon, Ph.D., lead researcher and associate professor at the University of Florida’s College of Medicine, “it is important to identify effective policies to tackle this prevalent problem.” Only about 30% of children enrolled in the federal health insurance program under the age of 5  receive critical dental services, even though comprehensive dental benefits are required in Medicaid. It is more likely that Medicaid participants will receive medical care (instead of dental care), which is why most U.S. states have adopted policies that reimburse basic dental screenings and preventative treatments for primary medical care providers. The covered services often include topical fluoride application, parental counseling, mouth exams, and overall assessment for risk of tooth decay, according to a recent Medical News Today article.  Previous studies have found that fluoride application combined with parental counseling can reduce tooth decay in high-risk kids by up to 50%.

The policy in Florida covers kids from 6 through 42 months of age, and after close analysis, researchers found that many of them are benefiting from it. The study examined the reimbursement data on more than 1 million children in Florida and found over a 100% increase in dental preventative services. After carefully considering variable factors, such as age and length of Medicaid enrollment, the kids covered under the new policy were found to be 20% more likely to receive oral health preventive services than before the policy was enacted. While these early treatments are not enough to ensure good oral health over a lifetime, it’s a wonderful start and has the potential to be a critical component in the battle against oral disease.

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