Oral Health for Children in Health Reform Discussions Meg Booth Executive Director Children’s Dental Health Project February 28, 2017

Children’s Dental Health Project In 1997, Children’s Dental Health Project was created to advance innovative policy solutions so that no child suffers from tooth decay. We are driven by the vision that all children will achieve optimal oral health in order to reach their full potential. CDHP Goals: Prevent childhood tooth decay. Ensure all children have affordable comprehensive care that improves their oral health.   Measure for the oral health we want for our children. 

Key Messages Oral health is critical to children’s overall health. Preventive oral health care has a lifelong impact on children and their families. Dental care remains vulnerable when not specifically addressed in policy decisions.

Oral Health vs Tooth Decay Tooth Decay Is Preventable Dental caries is the disease that causes cavities/tooth decay Caries is the #1 chronic condition in childhood Dental caries is an infectious disease transmitted primarily from mother-to-child through bacteria in saliva Dental Caries Is a Progressive Chronic Disease 23% of 2-5 year olds have experienced a cavity, and 56% of kids ages 6-8 53%-79% of children treated in the OR for severe caries will experience new cavities within 2 yrs. Children with cavities in baby teeth are 3x more likely for adult decay

The High Cost of Poor Oral Health Poor Oral Health Hurts School Performance Children with poor oral health 3x more likely to miss school Children with poor oral health are 4x more likely to earn lower grades Poor Oral Health is Costly The costs of treating children for rampant tooth decay in a Denver hospital (2014) ranged from $10,000 to $15,000 per case. Poor Oral Health Limits Economic Success Good oral health may increase annual earnings by up to 5% Missing and visibly decayed teeth harm employment opportunities Poor Oral Health Impacts our National Security In 2012, 62% of U.S. Army new recruits were not immediately deployable because of a significant dental issue S.L. Jackson et al., “Impact of poor oral health on children’s school attendance and performance,” Amer J of Public Health, Oct. 2011; H. Seirawan et al., “The impact of oral health on the academic performance of disadvantaged children,” Amer J of Public Health, Sept. 2012. Estimated cost by Denver Health official, Colorado Public Radio (2015). Glied, Sherry, and Neidell, Matthew. "The economic value of teeth." J of Human Resources 45.2 (2010): 468-496. Hyde S, Satariano WA, Weintraub JA.” Welfare dental intervention improves employment & quality of life.” J Dent Res. 2006; 85(1):79-84. Bipartisan Policy Center. 2012. Lots to lose: How America’s health and obesity crisis threatens our Economic Future. Bipartisan Policy Center.

Medicaid Dental for Children EPSDT dental care minimum standard: “relief of pain and infections, restoration of teeth, and maintenance of dental health.” l Each state Medicaid program determines its own dental periodicity schedule in consultation with recognized dental organization(s). Oral health benefits are stabilized as part of the EPSDT package, but allows states to determine the design base on their unique needs.

Medicaid Innovation in Oral Health Innovation in Medicaid dental programs include: Adoption of risk assessment codes to improve care and accountability (AZ, CT, DE, IL, MT, NJ, TN, TX) Use of new pharmaceuticals to stop decay with high-risk patients Use of tele-dentistry and allied health professionals (CA, CO, HI) Integration of oral health services into medical and social services settings (nationally) Incorporation of oral health into accountable care organizations (OR, possibly MA)

Oral Health Innovation in Medicaid Oral health payment and service delivery innovation is happening: 16 states: Perinatal and Infant Oral Health Quality Improvement initiative 4 awards: CMMI Health Care Innovation Awards 3 states: CHIPRA Quality Demonstration grants 1 state: California 5-year Dental Transformation Initiative Multiple states: State Innovation Models (SIM) Coming soon: CMS IAP Medicaid Payment Reform in Children’s Oral Health

Children’s Health Insurance Program (CHIP) Created in 1997, CHIP did not include a dental benefit until 2010 (CHIPRA 2009) – which made the benefit vulnerable to being cut in difficult budget years. States determine the structure and benchmarks that meet the basic benefit standards. The program was reauthorized in ACA until 2019, however funding ends Sept. 2017.

Dental Coverage Improves Health Medicaid and CHIP enrolled children to see dental providers on par with their privately insured peers Publicly insured children receive dental care at equivalent or better rates than privately insured children – adjusted for family income (Shariff, J. et. al) In some states, Medicaid children are more likely to access dental care than their privately-insured peers. Children with Medicaid/CHIP with dental care have fewer unmet dental needs Public insurance is associated with fewer unmet dental needs, particularly for children who had visited a dentist in the last 12 months

Oral Health is a Smart Investment The investments in children’s dental coverage is paying off with reductions in disease and decreasing treatment costs. Children that have benefited from public dental programs will be transitioning into the workforce with fewer oral health problems and lower dental care needs. CMS and Congress should encourage state innovation under current system to further improve oral health.

Contact Information Meg Booth, MPH Executive Director E: mbooth@cdhp.org P: 202.417.3598 www.cdhp.org www.endcavities.org @Teeth_Matter