Oral health:
Integral to well-being
Expanding children's access to &
use of oral health services
Children’s oral health is easily maintained with routine preventive care. But common problems such as decay become debilitating when left untreated. Untreated tooth decay is progressive and can undermine children’s long-term health, educational achievements, self image, and overall success.
The American Academy of Pediatric Dentistry recommends that children visit a dentist every six months, once their first tooth appears or no later than their first birthday. Only 70% of California’s children, ages 2-11, have seen a dentist within six months.
Promoting children’s oral health is a good policy: oral health is integral to children’s well-being and investing in it makes solid financial sense for all Californians. For every dollar spent on preventive oral health care, as much as $50 is saved on restorative and emergency oral health procedures.
Preventable oral health problems in children also are a considerable cost to the education system. In California, students miss an estimated 874,000 school days annually due to dental problems. These absences cost local school districts approximately $28.8 million. Because the state already lags behind the rest of the nation on key measures of academic achievement, including per pupil spending, it cannot afford to let poor oral health further compromise children’s education.
THE CHILDREN’S ORAL HEALTH CRISIS IN CALIFORNIA
Too few California children visit a dentist and get the preventive oral health care they need. Children of color and low-income children are the least likely to get basic dental services, exacerbating disparities in health and economic outcomes. California ranks near last in the nation on children’s oral health status, with approximately 20% of California children under the age of 12 having never seen a dentist. California’s poor and low-income children, in particular, lack needed access to quality oral health care. For example, only 59% of children covered by Healthy Families (California’s Children’s Health Insurance Program) vist a dentist each year; African American and Latino children access dental services less frequently than white children; and, for low-income children in 13 of California’s 58 counties, no dentists accept Medi-Cal. In spite of these ominous statistics, children’s oral health issues are often overlooked and underprioritized by policymakers. State funding for children’s oral health is now even less adequate due to recent cuts, including:
- Eliminating adult Denti-Cal (California’s Medicaid dental program), thereby slashing income for safety-net dentists who also treat over 3.5 million children enrolled in Medi-Cal.
- Indefinitely suspending the state’s Children’s Dental Disease Prevention Program, which provided school-based oral health care to over 300,000 children per year.
- Weakening dental benefits in the state’s Children’s Health Insurance Program (CHIP) known as Healthy Families, which provides health, dental and vision coverage to nearly 900,000 children.
EXPANDING THE DENTAL WORKFORCE TO MEET CHILDREN’S NEEDS
Growing numbers of California children are unable to access needed dental care because of a lack of dentists willing to treat them. Barriers to accessing needed dental care include provider shortages, a misdistribution of dentists in relation to children who need care, low provider payment rates, and the limited number of providers willing to see children enrolled in Medi-Cal and Healthy Families, as well as children with special health care needs. Only 37% of Medi-Cal-enrolled children received dental care in 2008. With the passage of health care reform, approximately 1.2 million California children are expected to gain health coverage over time, leading to an even greater mismatch between the number of available providers and the number of children seeking dental care.
One strategy to increase underserved children’s access to high-quality oral health care is to expand the capacity of the dental team. Expanding the dental workforce will allow dentists to use their time more efficiently and give more children greater access to routine and preventive services. Such models that utilize providers with carefully defined scopes of practice have proven to be a successful strategy in Alaskan native communities and in over 50 other countries.
FEDERAL ORAL HEALTH POLICY FOR CHILDREN
Federal Health Care Reform
The Patient Protection and Affordable Care Act (ACA) includes new opportunities to improve children’s access to dental coverage, preventive care, and public education about oral health. For example, the ACA outlines the minimum “essential health benefits” that private coverage will need to provide, and it specifically calls out dental care as part of a broader set of required pediatric services. Children Now is focusing on several opportunities for improving children’s oral health in the ACA, but as of yet, many of these programs remain unfunded. For example, the ACA seeks to expand school-based dental sealant programs, which provide a preventive dental service easily accessed by the children who are the most in need: low-income children, children in immigrant families and children of color. This is especially relevant because California budget cuts eliminated funding for the state’s only school-based preventive oral health program, which was particularly damaging to these populations. Other ideas that have yet to receive funding are the development of an oral health prevention and education campaign, and coordination of research that focuses on dental caries management.
Pediatric Oral Health Action Plan
In April 2011, the Centers for Medicare and Medicaid Services (CMS) announced an effort to work with states to improve access to oral health services for children enrolled in Medicaid and CHIP through the creation of state pediatric oral health action plans. Children Now has brought this opportunity to stakeholders who have helped brainstorm several ideas that California could incorporate into the plan. Children Now will work with other groups to develop a strong and united advocacy effort to capitalize on this opportunity and ensure the plan is appropriately prioritized to boost children’s access to oral health services.
Children’s Health Insurance Program Reauthorization Act
The federal Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA 2009) vastly improved policies for CHIP-eligible children in all states, including California, and provides California with opportunities to improve quality and access to dental care for low-income children. Children Now is working with state administrators to leverage these opportunities.
- Key Provisions: CHIPRA 2009 requires dental benefits in the CHIP package and allows states that already cover uninsured children to 250% of the federal poverty level to use CHIP funds to provide dental coverage to otherwise eligible underinsured children (e.g., children who have health but not dental insurance). CHIPRA 2009 also requires new standardized reporting of information about children’s dental health, and improved accessibility of dental provider information for Medicaid and CHIP enrollees.
- Impact on California: The federal decision to require all states to provide dental benefits in CHIP bolsters California, which already provides dental benefits through Healthy Families.