1996
- Children’s Dental Services Under Medicaid: Access and Utilization (report) released
Background
At this time, dental caries (tooth decay) remained the most common disease among children and adolescents. Higher levels of dental caries were generally found among children and adolescents from minority groups, those from families with low incomes, and those whose parents had less than a high school education. The oral health care delivery system was not meeting the oral health needs of all Americans, especially those unable to afford oral health care, those who had no dental insurance, and those at high risk for oral disease.
In 1991, 5.2 million Medicaid recipients received oral health services, which represented less than 17 percent of all Medicaid recipients, and expenditures for these services represented less than 1 percent ($709 million) of the $77 billion spent on Medicaid. Expenditures for oral health services were the only health service expenditures that decreased since 1975—by 29.7 percent.
A number of states, as well as the Health Care Financing Administration (HCFA), the Administration for Children and Families, the U.S. Public Health Service, and the Office of the Assistant Secretary for Planning and Evaluation expressed concern about the lack of dentists willing to provide oral health services for children enrolled in the Early and Periodic Screening, Diagnostic, and Treatment Program (EPSDT). The Office of the Inspector General interviewed Medicaid and dental public health officials in all 50 states and the District of Columbia. A sample of Head Start health directors, national and state dental society representatives, private practice dentists, advocates, and other experts were also interviewed. Results confirmed that few children received EPSDT dental services and that the extent of the problem varied significantly from state to state. HCFA data showed that only one in five children who were eligible for Medicaid received preventive oral health care, three-fourths of states provided preventive oral health care to fewer than 30 percent of children eligible for services, and no state provided preventive oral health services to more than 50 percent of children eligible for services.
Impact
The report found that reasons for low utilization rates included few dentists willing to serve children eligible for Medicaid, families giving oral health care low priority, and dentists’ belief that young children are difficult to serve. The report concluded that prevention and early, regular oral health care was the best strategy to improve the oral health and quality of life of all children.
Sources
U.S. Department of Health and Human Services, Office of Inspector General. 1996. Children’s Dental Services Under Medicaid: Access and Utilization. San Francisco, CA: U.S. Department of Health and Human Services, Office of Inspector General.
U.S. Public Health Service, Oral Health Coordinating Committee. 1993. Toward improving the oral health of Americans: An overview of oral health status, resources, and care delivery. Public Health Reports 108(6):657–672.
- Health Centers Consolidation Act passed
Background
The Health Centers Consolidation Act of 1996 (Public Law 104-299) amended section 330 of the Public Health Service Act. Health centers that receive funding under section 330 are required to provide primary health services. Health centers covered by these requirements include community health centers providing care to medically underserved populations; those serving migratory and seasonal agricultural workers and their families; those serving people who are homeless; and those serving residents of public housing. These expectations also apply to school-based health centers funded through the Healthy Schools, Healthy Communities program. Federally qualified health center look-alikes are governed by these expectations.
Impact
The legislation reauthorized and consolidated four federal health primary care and prevention programs: community health centers, migrant health centers, health care for the homeless, and health care for residents of public housing programs. All health centers receiving section 330 funding must provide, directly or through cooperative arrangements or contracts, oral health screening, education, and preventive services for designated underserved populations.
Sources
U.S. Congress. 1996. Health Centers Consolidation Act of 1996. Public Law 104–299–Oct. 11, 1996.
Bureau of Primary Health Care. 1998. Health Center Program Expectations. Rockville, MD: Bureau of Primary Health Care.
- National Maternal and Child Oral Health Resource Center established.
Background
In 1995, the Maternal and Child Health Bureau (MCHB) conducted a needs assessment to determine professionals’ access to timely and current information and materials focusing on the oral health needs of infants, children, adolescents, and families. Based on a comprehensive needs assessment completed by representatives of federal and state agencies and professional associations and organizations, the following concerns were identified:
- Resource and information centers focusing on oral health existed, but none focused on the oral health status of infants, children, adolescents, and their families.
- Information and materials produced by oral health programs were not being collected in a central location for easy reference and retrieval.
- Information, materials, and knowledge gained (lessons learned) from completed and currently funded projects were not widely available to help professionals develop, implement, and evaluate programs and services.
- Information, materials, and lessons learned needed to be disseminated more broadly to help ensure the greatest impact from limited resources.
In response to these concerns, MCHB established the National Maternal and Child Oral Health Resource Center (OHRC) to respond to the needs of states and communities in addressing current and emerging public oral health issues.
Impact
OHRC supports health professionals, program administrators, educators, policymakers, and others with the goal of improving oral health services for infants, children, adolescents, and their families. The resource center collaborates with federal, state, and local agencies; national and state organizations and associations; and foundations to gather, develop, and share quality and valued information and materials. As a result of OHRC services, professionals working in states and communities have improved access to current and high-quality oral health information and materials.
Sources
National Maternal and Child Oral Health Resource Center. National Maternal and Child Oral Health Resource Center [website].
Personal communication with John Rossetti. 2010.
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