May 2019 Volume LIV Number 3


AAPD Evaluates Oral Health Services Offered Under Medicaid

Study is Among the First to Assess Each State’s Compliance Along with Best Dental Practices for Infants and Toddlers

May 2013 Volume XLVIX Number 3

 CHICAGO —March 4, 2013 In the March issue of The Journal of the American Dental Association (JADA), investigators from the American Academy of Pediatric Dentistry (AAPD)—the leading authority on childrens oral health—presented a study titled "State Medicaid Early and Periodic Screening, Diagnosis, and Treatment Guidelines: Adherence to Professionally Recommended Best Oral Health Practices." The report is the first to provide an assessment of each states compliance with recommended best practices for infants and toddlers as defined by state EPSDT schedules, reflected in services offered under Medicaid. The studys primary author, Dr. Jacqueline Hom, Ph.D. student and pediatric dentistry resident, University of North Carolina at Chapel Hill, completed the manuscript as part of her project as the AAPDs Samuel D. Harris Research and Policy Fellow.


Since 1991, the AAPD has offered detailed recommendations for professional pediatric oral health services, including guidelines for the frequency and content of dental visits. These recommendations begin at birth and include the content and timing of developmental assessments, clinical examinations and diagnostic tests. Due to the wide acceptance and endorsement of these recommendations, the AAPD guideline is the benchmark for professional guidelines on childrens dental periodicity schedules.


Medicaid is the largest public health insurance program for low-income Americans and it finances health care coverage for almost 60 million people, one-third of whom are children. Early and Periodic Screening, Diagnosis, and Treatment Guidelines (EPSDT) helps ensure that low-income children covered by Medicaid have access to comprehensive and periodic evaluations to target health conditions and problems for which growing children are at risk.


As a joint federal and state program, Medicaid is operated by the states within broad federal requirements. Medicaid programs differ substantially from state to state.1 Although adult dental benefits are optional, all states are federally mandated under EPSDT to cover comprehensive dental services for children under 21 years of age.


Under federal law, schedules specifying the content and periodicity of dental services under EPSDT must be established by each state after consultation with recognized dental organizations involved in child health care. Though all 50 states and the District of Columbia had a dental component to their EPSDT guidelines, 33 or 65 percent had separate dental EPSDT periodicity schedules and the ones that did included over 85 percent of recommended best oral health practices. Overall, states with separate dental periodicity schedules were more adherent to best oral health practices than states without separate dental periodicity schedules. Among states with separate dental EPSDT periodicity schedules, the following ten states were optimally consistent with best practice guidelines for periodicity and content: California, Georgia, Idaho, Iowa, Massachusetts, Pennsylvania, Rhode Island, Texas, Utah and Vermont.


"We are encouraged by the fact that the majority of the states had adhered to professional recommendations for the age one dental visit," said Dr. Jessica Y. Lee, who served as faculty mentor for the project and is the graduate program director of the Department of Pediatric Dentistry at the University of North Carolinas School of Dentistry, as well as national spokesperson for the AAPD.


Pediatric dentists are committed to the care of Medicaid and Childrens Health Insurance Program covered children, who account for about 25 percent of the typical pediatric dental practice. According to Dr. Paul Casamassimo, director of AAPDs Pediatric Oral Health Research and Policy Center, "Consistency of policy across the states related to periodicity has the potential to improve access and to develop workable systems for inter-professional care."