1. K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 0 Access to Dental Care: Issues and Challenges Diane Rowland, Sc.D. Executive Vice President, Henry J. Kaiser Family Foundation and Executive Director, Kaiser Commission on Medicaid and the Uninsured for Alliance for Health Reform Washington, DC July 25, 2008

2. K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 1 Setting the Context Surgeon General’s Report on Oral Health (2000) outlined key issues and challenges in oral health: Oral health is an integral part of physical and social health –Impacts school attendance and employability Low-income populations bear disproportionate burden of dental disease –Poor children are twice as likely to have untreated tooth decay Lack of dental coverage and barriers to access –Over 100 million lack dental benefits –Low provider participation in Medicaid –Low awareness of importance of oral health Need for effective oral health infrastructure and workforce

3. K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 2 Percentage of Children with a Dental Visit in the Last Year, by Insurance Status NOTE: Children ages 2 -17 SOURCE: Bloom and Cohen, Summary Health Statistics for U.S. Children: National Health Interview Survey, 2006.

4. K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 3 Role of Public Coverage for Dental Benefits Medicaid covers comprehensive dental benefits for children under EPSDT –Medicaid covers over 1 in 4 children in the US –Access to dental services limited to due to low provider participation SCHIP generally provides less comprehensive dental coverage to children than Medicaid –Some dental coverage for children in all but one state Medicaid coverage of dental benefits for adults is optional and far more limited –Over 1/2 of states provide no or emergency-only dental services –Dental is often the first Medicaid benefit states cut to contain costs, with adverse consequences for beneficiaries

5. K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 4 Key Challenges to Improving Dental Access Broaden coverage of dental care –More comprehensive SCHIP benefits –Provide coverage for adults –Include dental care in core package under health reform Increase provider participation in Medicaid program Build adequate oral health workforce and delivery system Improve oral health literacy and patient support