On November 11, 2020, the NCIOM published a report that describes the progress made toward implementing the recommendations of the Task Force on Children’s Preventive Oral Health Services.

Background

In 2012, the Centers for Medicare and Medicaid Services (CMS) asked states to develop a plan to increase the proportion of children ages 1 – 20 enrolled in Medicaid or Children’s Health Insurance Programs (CHIP) who receive any preventive dental services, and the proportion of children ages 6 – 9 who receive a dental sealant on a permanent molar tooth by 10 percentage points over 5 years. The Task Force on Children’s Preventive Oral Health Services was convened to help the North Carolina Division of Medical Assistance (DMA), now called the Division of Health Benefits (NC Medicaid), develop its dental action plan to improve access to preventive oral health services for all children in response to the request from CMS.

The task force, which included 35 members representing dental health professionals, state policymakers, public health and other health professionals, researchers, consumer representatives, and others, met monthly from December 2012 to May 2013 with the goal of examining the main barriers to the utilization of preventive oral health services for children enrolled in Medicaid and NC Health Choice and developing recommendations to address these barriers. The North Carolina Oral Health Action Plan for Children Enrolled in Medicaid and NC Health Choice, published in June 2013, includes 14 recommendations that could be pursued and promoted by both public and private stakeholders.

Key Findings

Two recommendations have been fully implemented since 2013, while 11 have been partially implemented and 1 has not been implemented.

Successes

• Effective January 1, 2019, overall reimbursement rates for dental services, including sealants for children, were increased 10%. NC Medicaid also retroactively implemented a temporary 5% reimbursement rate increase for all fee-for-service providers in response to the COVID-19 pandemic. (Recommendation 4.1)

• A school-based pilot program began in 2016 using grant funding from the Duke Endowment. This pilot program offers a full dental exam to children at participating schools, as well as preventive services to maintain oral hygiene after the initial exam. Although this pilot program has not been rolled out statewide, it has an ultimate goal of involving local health departments as contract-holders for private dental practices that participate in the program. (Recommendation 6.3)

Next Steps

The task force recommended that current dental payment policies should be examined to support dental homes that provide continuity of care and comprehensive oral health services, while also ensuring that dental providers who only offer diagnostic and preventive services have referral systems to connect patients to comprehensive oral health services when needed. This recommendation has been complicated by the existence of mobile providers in the state, and work remains to be done to build a referral system that links mobile and fixed-site providers. The transition to managed care may support the development of a comprehensive referral system for accreditation. (Recommendation 6.2)

The entire report with updates on all recommendations from the task force can be accessed here.