1. The State of Medicaid: Oral Health
National Association of Medicaid Directors Arlington, VA
November 7, 2016
Laurie Norris, JD
Senior Policy Advisor for Oral Health
Centers for Medicare & Medicaid Services (CMS)

2. Steady Progress on Access to Dental Care

3. CMS Advances Oral Health Initiative 2.0
Aim: Increase by 10 percentage points the proportion of children receiving a preventive dental service
National Goal:
FFY 11 Baseline = 42%
FFY 15 Progress = 46%
FFY 18 Goal = 52%
Each state has its own baseline and goal.

4. Preventive Dental Services, by State, 2015
Source: FFY 2015 CMS-416 reports, Lines 1b and 12b.
Note: With the exception of OH, the national FFY 2015 percentage used data reported by states as of August 30, 2016.

5. Identify and Leverage Partnership Opportunities
Assessing States Using Key Elements of a High Performing Dental Delivery System
Supply Side
Demand Side
Medicaid System
adequate rates
know about the dental benefit
good data quality
low administrative burden
can find a dentist
strong contracts
fast payment
can make an appointment
use EQROs well
expedited credentialing
have a dental home
effective monitoring
reasonable prior authorization
transportation
high stakeholder engagement
help with broken appointments
adequate agency staff
fair audits
strong collaboration with sister public health agency
collaborate with PCPs
Identify and Leverage Partnership Opportunities
local, state and national funders ∙ dental schools ∙ preschools ∙ WIC ∙ Head Start

6. Florida: 33% of children had a preventive dental service in FFY 2015
CMS’s 2013 approval of Florida’s 1115 waiver required MCOs to undertake Performance Improvement Projects (PIPs) on children’s oral health
Florida Medicaid agency:
Modified MCO contracts to include specific improvement goals and sanctions for not achieving them
Cleaned up dental claims and encounter data and reporting processes
Launched statewide branded outreach campaign
Achieved 12.4 percentage points of improvement by FFY 2015
Let’s take a look at two of those orange states, and what is going on to improve their performance.
First, Florida.

7. California: 37% of children had a preventive dental service in FFY 2015
In December 2015 CMS approved the state’s 1115 waiver renewal
The waiver dedicated $740M to dental improvement over five years
$194M for incentives to dentists for providing preventive dental services
$187M for incentives to dentists for providing year-over-year continuity of care
$172M to reduce early childhood caries using bundled payments for prevention, disease management and behavior change
$185M for local dental pilot projects
The state is required to achieve at least 10 percentage points of improvement in preventive dental services use by 2020
The state can earn an additional $10M by exceeding targets, up to 15 percentage points of improvement
Next California.

8. Technical Assistance Topic CMS Can Help States . . . Planning
Assess system strengths and opportunities for improvement
Identify focused improvement goals linked to prioritized actions
Contracting and Managed Care
Strengthen managed care contracts
Develop approaches to performance incentives and disincentives with health and dental plans
Work with plans to create impactful oral health performance improvement projects
Leverage opportunities in External Quality Review Organization contracts
Data
Learn how to report accurate and complete dental and oral health services data on the Form 416 and the child core measures
Workforce
Deploy payment policies to support robust use of non-traditional dental providers
Identify ways to simplify provider credentialing
Engage physicians to provide oral health services and refer to a dental home
Payment
Design alternative payment models to encourage change in provider practices to improve care and reduce costs

9. Distribution of dental delivery system types (by % of children ages 0-20)
Source: Medicaid.gov State Medicaid Profiles

10. Medicaid Adult Dental Coverage Varies WidelyAZ WA MN WY CO OR NV CA IA WI MI NE ME MO KS OH NY KY TN NC NH MA VT PA VA NJ DE MD RI HI AK SC NM OK GA TX IL UT CT WV ID AL ND DC MS LA MT SD IN AR FL
Emergency services only or no dental services covered (18)
1 to 4 services (18)
5 or more services (15)
Source: Medicaid Coverage of Dental Benefits for Adults, Medicaid and CHIP Payment and Access Commission, February 2015

11. Measuring Progress in Use of Dental Services
CMS Form 416 EPSDT Data
States report annually on 7 types of children’s dental and oral health services
CMS Child Core Set of Quality Measures
PDENT (preventive dental services)
TDENT (dental treatment services)
SEAL (sealants on permanent molars)
HEDIS Measures
ADV (annual dental visit)
Dental Quality Alliance
pediatric oral health quality measures (tested and validated)
adult oral health quality measures (under development)