November2019 -over- www.cdhp.org

HelpingkidsgrowuphealthyandreachtheirdreamswithdentalcoverageinMedicaid&theChildren’sHealthInsuranceProgram

Nochildshouldbeheldbackfromtheirdreamsduetodentaldisease.Whenkidshavegoodoralhealth,theyarebetterabletolearn,grow,andachievetheirpotential.Dentalcoverageopensthedoortothecarechildrenneedtostaycavity-freeorgettreatmentforadentalissuebeforeitbecomesmoreapainful,expensiveproblem.WithMedicaidandtheChildren’sHealthInsuranceProgram(CHIP),childrenandadolescentscancountoncomprehensivecoverage,includingdentalcare,whichisdesignedtomeettheiruniqueneedsinchildhood.

MedicaidandCHIPbothplayamajorroleincoveringAmerica’schildren:• Inrecentyears,kidshavemadeupaboutone-halfofallpeopleenrolledinMedicaid.i

• InFY2018,nearly46millionchildrenwereenrolledinmedicalanddentalcoveragethankstoMedicaidandCHIP,including9.6millioninCHIPand36.3millioninMedicaid.ii

MedicaidandCHIPchilddentalbenefitshelpkidssucceedinschoolandthroughouttheirlives:

• ChildrenwithMedicaidandCHIPcoveragearethreetimesmorelikelytogettheirdentalneedsmet,sokidscanfocusonachievingtheirdreamsratherthandentalpain.

• Withgoodoralhealth,childrendobetterinschool,whilekidssufferingfromtoothdecayarefourtimesmorelikelytoearnlowergrades.iii

• Girlswhogrowupwithgoodoralhealthearn4.5%moreinadulthoodthantheirpeers,supportingtheirownfamily’sfinancialsecurityandlocaleconomies.iv

November2019 -over- www.cdhp.org

Medicaid’sdentalcoverageforkidsisdesignedtomeettheirunique,comprehensiveneeds:

• ChildrenandadolescentsenrolledinMedicaidgetservicesthroughtheEarlyandPeriodicScreening,Diagnostic,andTreatment(EPSDT)benefit.

• Ataminimum,EPSDTrequirescoverageofdentalservicesfor“reliefofpainandinfections,restorationofteeth,andmaintenanceofdentalhealth,”inaccordancewithstatebenefitpolicies(periodicityschedule)thatoutlinestheminimumfrequencyoftheseservices.

• EPSDTalsorequirescoverageofanyservicesnecessarytocorrectandamelioratehealthconditions.ThatmeanschildreninMedicaidareeligiblefortrulycomprehensiveandindividualizedcare,designedtomeettheiruniquephysicalandoralhealthneeds.

CHIPalsocoverstheoralhealthcarechildrenneedtogrowuphealthy:• InstatesthatexpandMedicaidtocoverchildrenwhoarealsoeligibleforCHIP,health

anddentalcoverageisprovidedthroughEPSDT.

• InstateswithseparateCHIPprograms,statesareexpectedtoprovidethedentalservicesnecessaryto“preventdiseaseandpromoteoralhealth,restoreoralstructurestohealthandfunction,andtreatemergencyconditions.”

• TheseCHIPdentalbenefitsmaybebasedonaprivateinsurancebenchmarkplan.ThismeasuresometimesresultsindollarorfrequencylimitsoncertainservicesandcanmakecoverageslightlymorerestrictivethanEPSDT.

WhatCongresscando:Toputchildrenonapathtowardahealthy,successfulfuture,CongresscanensureMedicaidandCHIPremainstrongandaccessible.Lawmakerscanprotectandstrengthenfundingforthesecrucialprograms,andensurethatbothchildrenandparentshaveaccesstocomprehensivecarethatmeetstheirneeds.

iBrooks,T.&Whitener,K.(2017).MedicaidandCHIP101:MedicaidandCHIP’sFoundationalRoleinCoveringKidsandFamilies.Retrievedfromhttps://ccf.georgetown.edu/2017/12/19/medicaid-and-chip-101-medicaid-and-chips-foundational-role-in-covering-kids-and-families/.iiCentersforMedicareandMedicaidServices(2019)."FederalFiscalYear(FFY)2018StatisticalEnrollmentDataSystem(SEDS)Reporting.Retrievedfrom:https://www.medicaid.gov/chip/downloads/fy-2018-childrens-enrollment-report.pdfiiiSeirawan,H.,Faust,S.,&Mulligan,R.(2012).TheImpactofOralHealthontheAcademicPerformanceofDisadvantagedChildren.AmericanJournalofPublicHealth,102(9),1729–1734.doi:10.2105/ajph.2011.300478ivGlied,S.,&Neidell,M.(2010).TheEconomicValueofTeeth.TheJournalofHumanResources.45(2),468-496.doi:10.3368/jhr.45.2.468