New Directions for Medicaid and CHIP Dental Programs

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1 New Directions for Medicaid and CHIP Dental Programs 2011 MSDA Symposium!"##"$%&'(")*+$$,"-.'/*-! "#$%&'()!*)&!+&,%-.!/(*%-#!0'12'*3.!4'1,5! $ Monday, June 27, 2011 $

2 Our Mission! "7;!*$3.!-1!A(!*!3*B1'!61'8(!*)&!*!-',.-C1'-#=! 5*'-)('!61'!-#(!$35'1<(3()-!16!#(*%-#!*)&! #(*%-#!8*'(!61'!*%%!+3('$8*).!! "7";!8*''$(.!-#$.!3$..$1)!61'C*'&!C$-#!*! 5*'?8,%*'!(35#*.$.!1)!3*D$)2!7(&$8*$&!*)&! "/:0!-#(!A(.-!5'12'*3.!-#(=!8*)!A(!! 0*'-)('.#$5.!*'(!8'$?8*%!-1!.,88(..!

3 Profile of Children s Coverage, 2009 All Children 10% 33% 53% Children Below 133% Federal Poverty Level 15% 17% 66% Medicaid ESI Other Uninsured ;1,'8(F!!//;!+;0G!*)*%=.$.!16!-#(!HIJI!+)),*%!;18$*%!! *)&!G81)13$8!!;,55%(3()-!-1!-#(!",''()-!015,%*?1)!;,'<(=!

4 =.99*)9$2-*D$3("45-.)E9$3*<.-&1.$FG*-/9H$ I6''.99$"9$0*99"J4.$! K)$).,'*)8(!'*-(.!61'!!!"#$%&'(!#*<(!.-(*&$%=!! &'155(&!&,(!-1!!7(&$8*$&L "/:0! 0.-'.)/&1.$*2$3("45-.)$%"/(*6/$7.&4/($ Children below 200% of poverty 23% 16% 12%! "1<('*2(!%(<(%.!#1%&$)2!.-(*&=!(<()!$)!(81)13$8! &1C)-,')! Children above 200% of poverty 6% 5% % !

5 K(.$L..5$2*-$0-*1-.99$ While there have been notable improvements in the oral health of Americans, oral diseases remain prevalent across the country, especially in vulnerable and underserved populations. Institute of Medicine, Advancing Oral Health in America, April 8, 2011

6 M-&4$7.&4/($3&-.$89$F99.)N&4$/*$ O&")/&")")1$7.&4/($ Oral health can contribute to serious disease for adults and children: Relationships between oral health care and diabetes, osteoporosis, respiratory and vascular diseases, rheumatoid arthritis, oral cancers, and preterm low-birth weight pregnancy outcomes.

7 M-&4$7.&4/($3&-.$&)5$3("45-.)E9$7.&4/($ Better Health for Kids: Low-income children who receive preventive dental care by age 1 are less likely to require subsequent restorative dental work or visit an emergency room Lower Costs to the System: The dental costs of these children are almost 40 percent lower over a 5-year period than they are for children who receive their first preventive visit after age one

8 K(.$L..5$2*-$0-*1-.99$ Ensuring access to oral health care for lowincome children is a significant challenge: " 25 percent of children account for 80 percent of dental disease " Kids who live below the poverty level are twice as likely to have untreated decay " In 2009, only 38 percent of Medicaid eligible children received any dental services. M!

9 K(.$I/&/.$*2$3("45-.)E9$,.)/&4$7.&4/(H$ O&#")1$3*<.-&1.$O&P.-$ The Pew Children s Dental Campaign issued its State report card in May There is a sizeable gap between the number of children who need dental care and the number of children who receive it. In 2009, 16 million Medicaid- and CHIP-enrolled children did not receive any dental care. In 2014, an estimated 5.3 million more children will have dental coverage.

10 :&--".-9$/*$Q''.99$/*$,.)/&4$3&-.$ Limited availability of dental providers Low reimbursement rates Administrative burdens on providers Lack of clear information for beneficiaries Missed dental appointments Transportation Lack of cultural and linguistic competency Need for consumer information about benefits of dental care JI!

11 $ 36--.)/$R"9'&4$ $$ G)'1%%3()-!*31)2!6*3$%$(.!*)&!8#$%&'()!#*.!2'1C)!.#*'5%=!&,(!-1!-#(!'(8(..$1)! 7(&$8*$&!$.!$)-()&(&!-1!A(!*!81,)-('8=8%$8*%!5'12'*3! N(.5$-(!()'1%%3()-!2'1C-#9!.-*-(!7(&$8*$&!.5()&$)2! &(8%$)(&!&,'$)2!-#(!'(8(..$1)! O#$%(!()'1%%3()-!2'1C-#!(P5%*$).!'(8()-!2'1C-#!$)! !-#(!'(*%!81.-!&'$<('.!%$(!(%.(C#('(!! $ JJ!

12 Better Care, Better Health, Lower Costs 0*T64&N*)$ 7.&4/($ FST.-".)'.$ M2$3&-.$ )'&*+,-#.,* 3*9/$

13 ! 0'$3*'=!8*'(!5'1<$&('!$)8'(*.(!QHIJRS!! +881,)-*A%(!"*'(!T'2*)$U*?1).!! 7(&$8*%!*)&!#(*%-#!#13(.!! E,)&%(&!5*=3()-.!-1!$)-(2'*-(!8*'(!! 4%1A*%!5*=3()-!&(31).-'*?1).!! V1!5*=3()-!61'!/+".!! "()-('!61'!7(&$8*'(!*)&!7(&$8*$&!:))1<*?1)!"()-('!! W(&('*%!"11'&$)*-(&!#(*%-#!"*'(!TX8(!QYN,*%.ZS! $ New Tools: Delivery System and Payment Reform

14 3.)/.-$2*-$O.5"'&-.$U$O.5"'&"5$ 8))*<&N*)$ Purpose to test innovative payment and service delivery models to reduce program expenditures under Medicare, Medicaid and CHIP while preserving or enhancing the quality of care furnished Focus Better healthcare, better health, reduced costs Opportunity to scale up authority to expand successful models to the national level

15 V.'.)/$0-*1-.99H$$ 3OIE9$%*-#$*)$3("45-.)E9$M-&4$7.&4/($ 2008 reviews 16 states performing below 30% utilization 2010 reviews 8 states with promising practices 2010 announces Oral Health Initiative 2010 holds two multi-state collaborative workshops 2011 releases Oral Health Strategy

16 3OI$M-&4$7.&4/($8)"N&N<.$A$W*&49$ Modeled on Healthy People 2010 Goals - Increase the proportion of Medicaid and CHIP children (ages 1-20) who receive preventive dental care each year - Increase the proportion of children (ages 6-9) who receive a dental sealant on a permanent molar tooth (will be phased in). Goal: 10 percentage point increase over 5 years nationally and in each state. Baseline year is J[!

17 3OI$M-&4$7.&4/($I/-&/.1;$ Work with states to develop pediatric oral health action plans Strengthen technical assistance to states & facilitate peer-to-peer learning Outreach to providers Outreach to beneficiaries Partner with other HHS agencies

18 Innovative Practices Increase or reconfigure reimbursement rates (Alabama, Maryland, Nebraska, North Carolina, Texas, Virginia) Reduce administrative barriers (Alabama, Virginia, Maryland) G%$3$)*-(!1'!'(&,8(!5'$1'!*,-#1'$U*?1)!'(\,$'(3()-.!! K.(!.-*)&*'&!8133('8$*%!$).,'*)8(!&()-*%!(%(8-'1)$8!8%*$3$)2!61'3!! JM!

19 Innovative Practices Develop and improve collaboration and partnerships with stakeholders (Texas, Maryland, Virginia, Rhode Island, Nebraska)!.-*-(!5,A%$8!#(*%-#!*2()8=!h!.-*-(!&()-*%!*)&!&()-*%!#=2$()(! 1'2*)$U*?1).!h!.8#11%.!h!*&<18*-(.!h!%18*%!#(*%-#!&(5*'-3()-.! h.18$*%!.('<$8(!*2()8$(.!h!-'$a*%!1'2*)$u*?1).!h%(2$.%*?<(!%(*&('.! h1'*%!#(*%-#!81*%$?1).!h!#1.5$-*%.!h!5(&$*-'$8$*).!! Establish performance targets and feedback loops (Arizona, Rhode Island) Change the delivery system (Rhode Island, Maryland, Virginia) J^!

20 Innovative Practices Partner with dental schools for loan repayment assistance and public health clinical rotations (Alabama, Nebraska, Texas) Authorize dental hygienists to apply sealants without a prior dental exam (Nebraska, Maryland) Develop training and partner with pediatricians to perform oral health risk assessments, fluoride varnish, referrals (North Carolina, Maryland, Alabama, Rhode Island, Texas) Track and analyze gaps in access to care & design custom approaches to addressing identified gaps. (North Carolina) HI!

21 X.;$/*$V.&'(")1$M6-$W*&49H$ Q996-")1$/(&/$&44$0&-/).-9$&-.$$ &/$/(.$K&J4.$

22 L.Y$,"-.'N*)9$2*-$O.5"'&"5$ &)5$3780$,.)/&4$0-*1-&D9$ Vikki Wachino Director, Children and Adults Health Program Group Laurie Norris Coordinator, N$<$.$1)!16!_,*%$-=9!G<*%,*?1)!*)&!/(*%-#!T,-813(.! CMS Oral Health Initiative W*3$%=!*)&!"#$%&'()`.!/(*%-#!0'12'*3.!4'1,5! $ $

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