Five Ways to Improve the Oral Health of Medicaid-Enrolled Children

Early oral health care is essential for all children. So, it’s good news that Medicaid mandates comprehensive dental coverage for enrolled children until they’re 21 years old. But families with low incomes confront a persistent challenge: having coverage doesn’t guarantee access to care. Data show that children enrolled in Medicaid are less likely to receive the early dental care they need.

Thankfully, there are effective solutions that dental and medical professionals, oral health advocates, and others can advance to connect more Medicaid-enrolled children to care.

Children’s Oral Health Is Important, Especially for Those Enrolled in Medicaid

Medicaid requires states to cover health assessments and services for enrolled kids throughout childhood, according to a schedule set by the Early and Periodic Screening, Diagnostic and Treatment benefit. Yet several barriers push services out of reach. The hurdles are higher in some states than others. In Arizona, for example, research finds that only about one in four young children enrolled in Medicaid are receiving early dental care.

Leading dental and child health experts — including the American Dental Association, American Academy of Pediatrics, and American Academy of Pediatric Dentistry — agree that kids should have their first dental appointment by their first birthday. When left untreated, dental disease can have long-term consequences for children.

Early exams can help. They help prevent childhood dental disease before it starts or catch it before it worsens. More specifically:

• Children can get the care they need to stay healthy when providers can diagnose tooth decay early on.
• Early diagnosis leads to more preventive support as children grow up.
• Early diagnosis also means there’s less risk that a child will need oral surgery that can cost more than earlier care.

Unfortunately, many Medicaid-enrolled children don’t get a dental exam soon enough. National data show that most children enrolled in Medicaid have their first oral health exam at age 3. This delay in care increases the risk that young children will undergo more extensive dental care, like fillings, than preventive treatment.

Barriers to Oral Health Care for Children Enrolled in Medicaid

According to research, children enrolled in Medicaid have more oral health problems and see a dental provider less often than their peers with private coverage. Several factors make it challenging for children to access dental care:

1. There is a shortage of dental providers nationwide and many providers won’t see people enrolled in Medicaid.
2. Doctors and other primary care providers who perform well-child visits don’t conduct recommended dental exams often enough.
3. Data suggest nearly 1 million Medicaid-enrolled children rely on school-based oral health programs for basic dental care. The COVID-19 pandemic interrupted services and continues to cause disruptions for students.
4. Barriers based on structural racism remain a steep challenge.

Nationwide studies confirm the depth of these hurdles. Data from 13 states show that, in 2013, only 6% of children who had a well-child visit received an oral exam during the appointment. Four years later, in 2017, this level only improved by 1%.

Regarding school-based oral health programs, a 44-state survey affirms that the COVID-19 pandemic disrupted children’s dental care in many ways. The crisis forced oral health leaders to shift focus, taking time from school-based programs. Leaders had less capacity to inform school administrators, staff, and families about the program’s safety.

Many school-based oral health programs were still not fully operating in 2021. The research suggests that this challenge and others “may persist for years once the pandemic has ended.”

State-level data also offers a look at how other barriers to children’s dental health care play out.

An analysis of children’s dental health care information from Medicaid-enrolled children in Arizona provides one stark example. Experts find that less than 1% of Arizona children enrolled in Medicaid had a dental visit before turning 1 year old. The hurdles they confront align with national trends:

• Overall, the state does not have enough dentists to care for people in rural and low-income communities.
• The provider shortage is a particular problem for children in Arizona. At least four Arizona counties do not have a pediatric dentist to treat Medicaid-enrolled children.
• The state also contends with deep racial disparities. Compared to other racial groups, American Indian or Alaska Native children are the least likely to have a dental visit by age 1. They also travel the farthest to get care.

How to Increase Children’s Access to Oral Care

There are steps that health providers, advocates, and others can take to make progress securing early oral health care for Medicaid-enrolled children.

These first three solutions can bolster school-based oral health programs, since so many children in low-income families count on such programs for care:

1. Preserve programs by prioritizing what services to offer and where to provide them. School-based oral health program leaders can consider using a mobile dental van or shifting care to a different community building to keep care open to students.
2. Plan to adapt programs in a future public health emergency. Leaders can explore using telehealth to give children and their families virtual guidance on developing healthy dental habits at home.
3. Create materials to inform school administrators, school staff, and students’ families about the safety and importance of school-based oral health program services. Engaging educators and the school community about children’s oral health can help it remain a priority.
   
   Outside of school, here are two other effective approaches to improve access:
    
4. Dental education institutions can boost the number of providers who know how to support kids. They can increase training in dental schools to equip general dentists, who normally care for adults, to treat children.
5. Dental and medical providers can expand interprofessional efforts and integrate children’s oral health into their primary care. This coordination can ensure the right follow through happens. With stronger connections, primary care providers will have a dental network to refer to after conducting a well-child visit with an oral exam. Early oral care is critical to children’s overall health.

These solutions can help children enrolled in Medicaid get the early care they need.