helping kids grow up healthy and reach their dreams with dental …coverage/cdhp+fact... ·...
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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