Module 1: An Overview of Children with Special Health Care Needs and Oral Health
Special Care- Overview of CSHCN

1.4 Opportunities for Oral Health Care Delivery and Financing

Guidelines from several professional organizations recommend that all children should be referred to a dentist 6 months after the first tooth erupts or by age 12 months (whichever comes first) for establishment of a dental home. 13, 14 A dental home is a comprehensive, continuously accessible, and affordable source of oral health care under the supervision of a dentist. Children who have a dental home are more likely than those who do not to receive appropriate preventive and routine oral health care. 14 Depending on individual risk factors, CSHCN may need to visit an oral health professional every 2 to 3 months for preventive care.

Children with special health care needs may require a visit to an oral health professional every 2 to 3 months for professional preventive care.

Many dedicated oral health professionals currently provide care for CSHCN. General dental practices in small communities, pediatric dental practices, dentists who participate in Medicaid, and older dentists are more likely than younger ones to provide care for CSHCN. 15 Oral health professionals working in dental practices, schools of dentistry and dental hygiene, specialized residential facilities or hospitals, and university centers of excellence for developmental disabilities are important sources of care. Experiences acquired during professional training or continuing education courses are motivating factors for increasing oral health professionals’ willingness to provide care for this population and for increasing their confidence in providing such care. The Commission on Dental Accreditation Standards for dental hygiene education programs and for dental education programs include standards stating that graduates must be competent in assessing the treatment needs of patients with special health care needs. 15, 16

Examples of Oral Health Care Delivery and Financing Programs and Services

Head Start
Head Start programs allocate a minimum of 10 percent of their enrollment to children with disabilities who are determined to be eligible for special education and related services or early intervention services, as appropriate. “As appropriate” is determined under the Individuals with Disabilities Education Act, by the state or local agency providing services under section 619 or part C of the Individuals with Disabilities Education Act. In addition, Head Start programs work with local agencies to help families enroll in public assistance programs or to obtain other sources of funding for oral health care. Head Start Program Performance Standards specify that programs should work with dentists to ensure that children receive an oral examination, that a treatment plan is developed, and that necessary treatment is completed for all children enrolled in the program. 17

Maternal and Child Health Services
The Maternal and Child Health Services Block Grant (Title V) requires that states budget at least 30 percent of their federal allocation to services for CSHCN. Title V funds may be used to provide case-management services to families to improve access to oral health care and to support collaboration between special health care needs programs and oral health programs. 18

To find out which services for children with special health care needs your state covers, contact your state dental director or your state maternal and child health director or state children with special health care needs director.

All children enrolled in Medicaid, including those with special health care needs, are entitled to comprehensive oral health services through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. Ages for the provision of services and benefit packages vary by state. Oral health professionals should keep abreast of changes in their state’s Medicaid and Children’s Health Insurance Program (CHIP) coverage and regulations, as they frequently change. States use a variety of reimbursement methods for targeted case management, a service that assists families in gaining and coordinating access to oral health services appropriate to their needs. In many states, Medicaid eligibility is automatic for recipients of Supplemental Security Income (SSI). In other states, a separate Medicaid application is needed, while in others, SSI eligibility criteria are different than Medicaid eligibility criteria. Find out what the situation is in your state to help families determine whether their child is eligible for these dental benefits.

Grottoes of North America’s Humanitarian Foundation
The Grottoes of North America’s Humanitarian Foundation’s Dental Care for Children with Special Needs Program partners with dentists throughout the country to bring community-based oral health services to CSHCN under age 18 with one or more of the following conditions: (1) cerebral palsy; (2) muscular dystrophy; (3) intellectual disabilities, including Down syndrome; and (4) organ transplant recipients pre and post. Children enrolled in Medicaid are not covered by the program. The program is the secondary carrier when a child had dental insurance and the primary carrier when the child does not have dental insurance, in which case the program covers the maximum allowable fees as determined by the foundation.

Special Olympics
The Special Olympics, Healthy Athletes, Special Smiles program works to increase public awareness of the oral health issues facing children and adults with special health care needs, increase their access to care, and train professionals to care for them. The program provides Special Olympics athletes with oral health screening, education, and referrals to dentists in their community for routine oral health care and treatment.