Fla. study hails impact of reimbursing primary doctors for oral screenings

A change in Florida's Medicaid policy to reimburse pediatricians and other medical primary care providers for basic oral health screenings and cavity prevention has increased the likelihood of children in the state receiving these essential services by 20%, according to a recent study by University of Florida (UF) researchers.

The policy in Florida took effect in April 2008. It covers children ages 6 months to 42 months and reimburses primary care providers $27 for the oral health screenings and cavity prevention services, including topical fluoride application, parental counseling, oral exams, and risk assessments for tooth decay. Topical fluoride application, combined with parental counseling, has been shown to reduce tooth decay by up to 50% in high-risk children, according to a UF College of Dentistry press release.

Only 31% of publicly insured children younger than age 5 receive dental services in the U.S., the dental school noted. Preschool-aged children enrolled in Medicaid are more likely to receive medical care than dental care, even though comprehensive dental benefits are included in Medicaid.

Florida is one of 47 U.S. states that have implemented policies to reimburse primary care providers for childhood tooth decay preventive services since 2000. Florida is ranked 50th in the U.S. in dental care rates among Medicaid-enrolled children.

In the study published by Health Services Research (July 8, 2014), the researchers, including Scott L. Tomar, DMD, MPH, DrPH, and Frank Catalanotto, DMD, of the department of community dentistry and behavioral science in the UF College of Dentistry, looked at reimbursement data on more than 1 million children in Florida and almost 2.1 million children in Texas, which enacted a similar policy, for a total sample size of more than 3.1 million.

Florida saw a 130% increase in services such as oral health screenings and topical fluoride applications for the children covered. Even after controlling for factors such as age and length of Medicaid enrollment, children covered under the policy were 20% more likely to receive oral health preventive services than before the policy was enacted when compared with a group of children who were too old to be covered under this policy.

Lead study author and researcher Jill Boylston Herndon, PhD, an associate professor in the department of health outcomes and policy at the UF College of Medicine and a faculty member of the Institute for Child Health Policy, said preventing tooth decay and establishing a "dental home" is a priority.

"Given the high stakes for untreated tooth decay on children's overall health and well-being, especially among vulnerable and low-income children, it is important to identify effective policies to tackle this prevalent problem," Dr. Herndon noted in a statement. "Particularly among very young children, medical primary care providers serve as the gateway to the healthcare system and can play an important role in preventing tooth decay and facilitating the establishment of a dental home."

The study findings have "far-reaching public health implications" since Medicaid covers more than one-third of all U.S. children, according to the UF College of Dentistry.

In response to the findings, Beth Kidder, the assistant deputy secretary for Medicaid Operations at the Agency for Health Care Administration in Tallahassee, said in the release that her department was committed to increasing the number of Medicaid-enrolled children who receive preventive dental services.

"We are pleased that our policy change is expanding good oral healthcare to more children," she stated.

The study was funded by the National Institutes of Health.