Addressing Inequities through Innovations in Oral Health Policy

States have made great strides in improving children’s oral health, this includes a greater number accessing the dentist and a decline in untreated caries—tooth decay. Medicaid and the Children’s Health Insurance Programs (CHIP), which insure our nation’s most vulnerable populations, have played an important role by covering dental benefits for children. Some Medicaid agencies opted to expand dental coverage for adults as well. The adult population is often left with limited, emergency, or no dental benefits. Despite these important policy changes, oral health inequities persist. Preventable caries remain the leading chronic disease among children; Black and Latino children and adults not only have more untreated tooth decay but also more severe tooth decay; and low income adults, especially lower income older adults face barriers in obtaining care. Poor oral health not only has implications for overall health but the wellbeing of society. Eighty-two percent of adults say that the appearance of their mouths affects their ability to interview for a job, while 39 percent of low-income adults say that life is less satisfying given the condition of their mouths. These findings reveal the far-reaching implications of poor oral health. This blog highlights strategies for addressing oral health inequities discussed recently at NASHP’s 29th Annual State Health Policy Conference’s Oral Health Preconference, which was supported by the DentaQuest Foundation.

Statewide Medicaid Transformation

  • California’s Dental Transformation Initiative is its first Medicaid 1115 waiver that incorporates oral health. The effort aims to improve children’s oral health by targeting four domains: increasing number of children who receive a preventive dental service; leveraging incentive payments to support providers in pilot sites to carry out treatment plans that promote targeted disease management; promoting continuity of care through a dental home; and mobilizing pilot projects that target these domains.
  • Through its federal waiver, Oregon leverages Coordinated Care Organizations (CCOs) as its accountable care strategy to achieve the Triple Aim through a single budget covering physical health, mental health, and oral health services for Medicaid-enrollees. The state uses quality incentives for the work the CCOs carry out with contracted Dental Care Organizations and has seen improvements across racial and ethnic groups in the number of children who receive a dental sealant since 2014 and in the number of elementary and middle school students served in the school dental sealant program in the 2015-2016 school year.

Insurance Benefit Design

  • Oklahoma adopted reimbursement of silver diamine fluoride for Medicaid-eligible pediatric visits, which supports caries management. Silver diamine fluoride is an effective and affordable material that arrests and prevents caries, removing barriers for patients at higher risk for caries and patients with medical or psychological challenges.
  • Connecticut’s state-based insurance exchange facilitates plan design and consumer cost sharing considerations by requiring plans to embed pediatric dental benefits while also offering stand-alone dental plans for adults.

Local Care Delivery Models

  • Maine’s From the First Tooth initiative aims to improve the oral health of pregnant women and infants by integrating oral health into primary care. The initiative focuses on optimizing workflows, dental referrals, and consumer education.
  • Through its Dental Emergencies Needing Treatment program, an accountable care entity in Washington State increases the number of patients with access to a dental home. Behavioral coaching and referral divert patients from emergency departments for dental care.

Ultimately, improving oral health is a mechanism for ensuring overall health and economic growth. As we prepare for a new administration, state officials and other stakeholders will continue to play a critical role in promoting oral health equity, lowering costs, transforming delivery systems, and improving quality care for the nation