NASHP

How States Address Social Determinants of Oral Health in Managed Care Contracts

November 2, 2020

Inequities in oral health and health outcomes are driven by social determinants of health (SDOH), including diet, education, transportation, and access to care. A growing number of states are working to improve the health of their Medicaid enrollees and reduce costs by addressing these social determinants in their managed care contracts. This map and blog highlight key findings in dental contracts and potential opportunities for states to leverage medical contract SDOH language in dental contracts to support oral and overall health. 

Map and Table Notes/Methodology

NASHP first collected all publicly available Medicaid managed care organization (MCO) contracts. For states with a separate dental benefits provider, NASHP searched for those contracts on each state’s Medicaid site. If the actual MCO or dental contract was not available, we used a request for proposals (RFP) for the state, or if neither of those was available, we used a request for information (RFI). Some contracts were previously provided by states. 

Each dental contract was then searched for the following social determinants of health (SDOH) using the associated terms. Medical contracts were scanned only for terms with an asterisk:

  • Adverse experiences:* Refers to search terms violence, trauma, social isolation, adverse childhood experiences, safety and physical environment;
  • Coordination with medical: Refers to search terms coordination (with MCO/medical), data sharing (with MCO);
  • Coordination with dental:* Refers to search terms coordination (with dental), data sharing (of or with dental or oral health), referral (to dental or oral health);
  • Coordination with community services:* Refers to search terms community and social supports, community resource directory, community health needs assessment, data sharing (with social services), referral (to social or community services), and social services;
  • Equity: Refers to search terms language, cultural competency, translation, readability;
  • Education: Refers to search terms education, educational attainment, school, school-based; 
  • Employment: Refers to search terms employment, job, work;
  • Food:* Refers to search terms food, food access, nutrition, SNAP, WIC, TANF;
  • Housing: Refers to search terms housing, homeless, rental assistance;
  • Transportation: Refers to search terms transportation, bus, mobile; and
  • Other: Employment (refers to search terms of employment, job, and work), child care (refers to search term of child care).

Information on the following topics was excluded:

  • Children and youth with special health care needs (CYSHCN);
  • Case management services;
  • Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services;
  • Health homes;
  • Home- and community-based services (HCBS) or long-term services and supports (LTSS);
  • Non-emergency medical transportation (from birth to age 21 under EPSDT); and
  • Panel and population health management.
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