Improving coverage

Through their Medicaid programs, states may offer specialized pregnancy benefits to women that target risks contributing to poor pregnancy outcomes.  Though such benefits are categorized as “optional” Medicaid services, they are seen by many as critical to optimizing maternal health and positive birth outcomes. These enhanced pregnancy benefits support women in having healthy pregnancies and contribute to improved infant and maternal health. Congress gave states the option to offer enhanced pregnancy benefits to pregnant women on Medicaid in 1985, and many states quickly took advantage of this opportunity, adding comprehensive non-clinical and medical pregnancy services to their Medicaid benefit packages. The use of enhanced pregnancy benefits peaked in 1993 when forty-four states provided at least one enhanced pregnancy benefit through Medicaid.

Dental disease is the most common chronic disease among children in the United States. Although Medicaid entitles children to medically necessary dental care under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, many children do not see a dentist until age 3 or later – even though cavity risk factors can be well established before a child’s first birthday and before the first tooth erupts. Untreated dental disease can lead to dietary problems, infection, missed school days, and a lower quality of life.

This paper discusses the options that states have to include dental benefits in a health care reform plan, if the state desires to do so. Oral health resides, for all intents and purposes, in a different world from general health. Dental care is separate in financing and insurance; provider education, licensing, and regulation; and service delivery. While ambitious health care reform plans have been undertaken in several states and proposed in others, no recent reforms have included dental benefits for the majority of those who are included in the new coverage. The primary barrier for states in including dental coverage is cost – although the traditional separation of general health and oral health – is a factor.

This State Health Policy Monitor examines the status of SCHIP dental benefits in the 39 states that have such benefits in their programs. The paper discusses the variations among states in covered services, cost sharing, and benefit caps.