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Research & Analysis

Report

The Cost of Delay

State Dental Policies Fail One in Five Children

Cost of Delay: Policy Benchmarks

Pew assessed and graded states and the District of Columbia on whether and how well they are employing eight proven and promising policy approaches at their disposal to ensure dental health and access to care for disadvantaged children.

 

Policy benchmark #1: State has sealant programs in place in at least 25 percent of high-risk schools.
Dental sealants are recognized as one of the best preventive strategies for children at high risk for cavities. Sealants—clear plastic coatings applied by a hygienist or dentist—cost one third as much as filling a cavity. Studies have shown that sealant programs targeted to schools with many high-risk children are a cost-effective strategy—but this strategy is vastly underutilized.
 
Percentage of high-risk schools with sealant programs, 2009Number of States
75-100%3
50-74%7
25-49%7
1-24%23
None11
 
Policy benchmark #2: State does not require a dentist's exam before a hygienist sees a child in a school sealant program. 
How many kids are served by a dental sealant program and how cost effective it is depends in part on whether the program must locate and pay dentists to examine children before sealants can be placed. Dental hygienists are the primary providers in school-based dental sealant programs, but states vary greatly in their laws governing hygienists’ work in these programs.
 
State allows hygienists to provide sealants without a prior dentist's exam, 2009Number of States
Yes30
No21
 
Policy benchmark #3: State provides optimally fluoridated water to at least 75 percent of citizens on community systems.
A 2001 Centers for Disease Control (CDC) study estimated that for every $1 invested in water fluoridation, communities save $38 in dental treatment costs. The CDC also identified community water fluoridation as one of the 10 great public health achievements of the 20th century and a major contributor to the dramatic decline in tooth decay over the last five decades. Yet more than one quarter of Americans do not have access to optimally fluoridated water.
 
Percentage of Medicaid children receiving any dental service, 2007Number of States
75-100%26
50-74%16
25-49%7
Less than 25%2
 
Policy benchmark #4: State meets or exceeds the national average (38.1 percent) of children ages one to 18 on Medicaid receiving dental services.
States are required by federal law to provide medically necessary dental services to Medicaid-enrolled children, but nationwide in 2007, only 38.1 percent of such children ages 1 to 18 received any dental care.
 
Percentage of Medicaid children receiving any dental service, 2007Number of States
59% or greater0
50-58%3
38.1-49.9%26
30-38.0%13
Under 30%9
 
Policy benchmark #5: State pays dentists who serve Medicaid-enrolled children at least the national average (60.5 percent) of Medicaid rates as a percentage of dentists’ median retail fees.
Dentists point to low reimbursement rates, administrative hassles and frequent no-shows by Medicaid-enrolled patients as deterrents to serving them. In 26 states, Medicaid programs reimburse less than 60.5 cents of every $1 billed by a dentist. Even in the three states with the highest scores, children on Medicaid still lagged behind the estimated 58 percent of privately insured children who use services each year.But states are taking steps to address these issues, and as a result are seeing significant improvements in dentists’ willingness to treat children on Medicaid and in children’s ability to access the care they need.
 
Medicaid reimbursement rates as a percentage of dentists’ median retail fees, 2008Number of States
100% or greater1
90-99%2
80-89%3
70-79%10
60.5-69%9
50-60.4%10
40-49%12
Less than 40%4
 
Policy benchmark #6: State Medicaid program reimburses medical care providers for preventive dental health services.
Doctors, nurses, nurse practitioners and physician assistants are increasingly being recognized for their ability to provide children in high need with preventive dental care. Currently, 35 states take advantage of this opportunity by making Medicaid payments available to medical providers for preventive dental health services.
 

Medicaid pays medical staff for early preventive dental health care, 2009

Number of States
Yes35
No16
 
 
Policy benchmark #7: State has authorized a new primary care dental provider, 2009
Some communities with a dearth of dentists, such as rural and low-income urban locales, have little chance of attracting enough new dentists to meet their needs. An increasing number of states are exploring new types of dental professionals to expand access and fill specific gaps. In a model proposed by the American Dental Association (ADA), these professionals would play a supportive role similar to a social worker or community health worker. In remote locations, the most highly trained professionals could provide basic preventive and restorative care as part of a dental team with supervision by an offsite dentist.In 2009, Minnesota became the first state in the country to authorize a new primary care dental provider.
 
State has authorized a new primary care dental provider, 2009Number of States
Yes1
No50
 
 
Policy benchmark #8: State submits basic screening data to the national database, 2009
Expertise and the ability to collect data and plan programs are critical elements of an effective state dental health program. They also are necessary for states to appropriately allocate resources and compete for grant and foundation funding—all the more important at a time when state budgets are increasingly strained.
 
State submits basic screening data to the national database, 2009Number of States
Yes37
No14
  

Report Assets

Date:
February 23, 2010
Contacts:
Matt Jacob | 202.540.6310
Project:
Children's Dental Campaign
Issues:
Dental Health

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PCS.PRODUCTION.1.20130430.1315 (PEWSUWVMWAPP01)