Increasing Missouri Children’s Dental Coverage Policy Position Paper

Missouri General Assembly

July 2007
Mary E. Homan, MA, Saint Louis University School of Public Health

The National Crisis of Dental Care for Children

Lack of dental coverage is a serious problem facing adolescents in Missouri. Lack of
health insurance exacerbates dental problems and dental coverage for Missouri’s children. Poor
oral health causes American children to lose 850,000 school days per year.1 Dental caries is the
single most common chronic disease of childhood, occurring five to eight times as frequently as
asthma, the second most common chronic disease in children. 80% of tooth decay occurs in only
25% of children- primarily children from low income families.2 31% of 6-8 year olds with tooth
decay go without treatment and almost 80% of tooth decay in poor children is untreated.3
African-American children, regardless of dental insurance type, were significantly less likely
than white children to have received preventative dental care. 4 2.6 times as many children did
not have dental insurance compared with those who had medical insurance.5 22.1% of US
children lacked parentally reported dental insurance coverage in the preceding year.6 26.9% did
not have a routine preventive dental visit.7 5.1% had parentally perceived unmet need for
preventive dental care.8 Only 58% of federally qualified health center grantees provide dental
services. Thus, nearly half of the 4 million children who obtain their routine health care in
community health care centers have no access to dental care in their health center.9,10

Impact of Lack of Coverage for Missouri Children

In Missouri, 45 percent of children hospitalized for preventable dental conditions and 53
percent of children who visit emergency rooms for dental related illnesses are MC+/Medicaid
Recipients.11 Nationally, only 20% of Medicaid-eligible children received routine preventive
dental services in 1993, compared to the 63% of the total children population who see a dentist
annually.12 71% of Missouri dentists do not take MC+/Medicaid patients at all.13 38% of
Missouri's 115 counties have no dentist willing to accept MC+/Medicaid patients.14 Citizens for
Missouri’s Children conducted a telephone survey in the St. Louis area in February 2000 using a
Department of Social Services list of MC+/Medicaid dental providers. Only 30% of the dentists
in private practice from the list were actually accepting any MC+/Medicaid.15 A child in the
Missouri Head Start program has an average of 6.5 weeks for a dental appointment.16
Current Policy on Dental Coverage
Dental services for the State Children's Health Insurance Program (SCHIP) are an
optional benefit under Title XXI of the Social Security Act for all children up to age 19. “Dental
services are available to all Medicaid eligibles. In the regions of the state where MC+ managed
care has been implemented, child enrollees have dental services available through the MC+
managed care health plans.”17 Dental services include: treatment of the teeth and associated
structure of the oral cavity; preparation, fitting and repair of dentures and associated appliances;
and treatment of disease, injury or impairments that affect general oral health. The Medicaid
plan provides payment for dental services for eligible fee for service Medicaid\MC+ recipients.
All dental services are covered by the MC+ health plan for children under 21.18

Policy Recommendations for Missouri

MC+/MEDICAID contracts should require plans to put traditional safety-net dental
providers and dental clinics in the provider network. The Department of Social Services should
require MC+/Medicaid Managed Care Organizations to include existing resources in its provider
networks, such as dental hygienists, community health nurses, health educators, WIC program
nutritionists, and pediatricians. Increase MC+/Medicaid reimbursement rates for all dental
procedure codes to 80%. Decrease in the administrative burden for dental professionals
participating in MC+/Medicaid. Establish an Oral Health Resource Program within the
Department of Health, Bureau of Dental Care, in collaboration with the Division of Medical
Services.

Action Requested
Legislators especially should engage in more aggressive outreach to give low-income
children greater access to dental services. Encourage dental insurance companies to pay for
dental sealants for children. Health Departments, particularly the State Department of Health
and Senior Services should increase oral health literacy in school curricula, particularly in the
primary grades. Increase the implementation of water fluoridation in new communities.
Increase the percentage of children and adolescents using fluoridated toothpaste, fluoride tablets,
and/or fluoride mouth rinses, particularly in areas with unfluoridated water.
Expected Outcomes
When Missouri’s children begin to utilize dental care more frequently, we will see fewer
school days missed due to dental caries, less utilization of emergency departments for care of
severe dental problems which will mean less tax-payer money used to reimburse emergency
department physicians. If insurance companies increase coverage, fewer children will need to
see specialists for progression of gum disease costing insurance companies less. Parents will
miss fewer work days taking care of sick children. Children will be healthier and happier and
will not need to obtain serious dental work at a young age. Overall, protecting Missouri’s
children by assisting in providing for dental coverage and working with payment reimbursement
plans for dentists and insurance companies will save the state of Missouri hundreds of thousands
of dollars by participating in preventative care as opposed to treatment of illness.
Charts Illustrating Problem of Dental Coverage for Children

Percentage of U.S. Children Age 5-17 Who Have Had Cavities, 1988-94.
Data Source: National Center for Health Statistics, CDC. Third National
Health and Nutrition Examination Survey, 1988-1994.
Works Cited
1
Gift, Recine S.T. & Larach, D.C, “Social Impact of dental problems and visits,” American Journal of Public
Health, 82; 1663-1668.
2
Edelstein, B.L., “Public Financing of Dental Coverage for Children: Medicaid, Medicaid Managed Care, and
State Programs,” Paper prepared for the Reforming States Group, San Francisco, CA, 1997. Available at:
http://www.aads.jhu.edu/legislative_affairs/ public_financing_of_dental_cover.htm.
3
Vargas, C.M., Crall, J.J., & Schneider, D.A., “Sociodemographic distribution of pediatric dental caries:
NHANES III, 1988-1994,” Journal of the American Dental Association, 129: 1229-1239.
4
Lewis C, Mouradian W, Slayton R, Williams A., “Dental insurance and its impact on preventive dental care
visits for U.S. children,” Journal of the American Dental Association, 2007 Mar;138(3):369-80.
5
Ibid.
6
Liu J, Probst JC, Martin AB, Wang JY, Salinas CF., “Disparities in dental insurance coverage and dental care
among US children: the National Survey of Children's Health,” Pediatrics, 2007 Feb; 119 Suppl 1:S12-21.
7
Ibid.
8
Ibid.
9
Edelstein BL., “Public and clinical policy considerations in maximizing children's oral health,” Pediatric Clinics
of North America, 47(5): 1177-1189.
10
MacKay AP, Fingerhut LA, & Duran CR., “Adolescent Health Chartbook,” National Center for Health Statistics,
Hyattsville, Maryland, 2000.
11
Missouri Department of Health, Missouri Information for Community Assessment (MICA), “Preventable
Hospitalization Statistics, 1997; Emergency Room Statistics, 1997,” Available at:
http://www.health.state.mo.us/BobPrevHosp/aller.html; http://www.health.state.mo.us/BobER/aller1.html.
12
Department of Health and Human Services (DHHS, “Healthy People 2000,” Washington D.C.: U.S.
Governmental Printing Office. Publication No. DHHS-PHS-91-50212.
13
McCunniff, M. et al., “Evaluation of the Missouri Dental Medicaid Program” Missouri Department of Health,
Bureau of Dental Health, Jefferson City, MO, 2005.
14
Missouri Head Start, 1999 Missouri Head Start Dental Survey, presented at the Missouri Coalition for Oral Health
Access Policy Forum, February 10, 2000, Jefferson City, MO.
15
Citizens for Missouri's Children conducted telephone surveys in February 2000 of St. Louis area dentists (St.
Louis City and County) using lists generated by the Medical Service Recipient Services Office. Seven
dentists on the state list were unreachable by phone.
16
Missouri Head Start.
17
State of Missouri Division of Medical Services Budget Book, 296. 2006.
18
Missouri Revised State statutes: RSMo 208.152, 208.166