Non-dentist oral health service use among Medicaid eligible children

Non-dentist oral health service use among Medicaid eligible children by:

 

Integrating preventive dental services and referrals in primary medical care

All children enrolled in a Minnesota Health Care Program can receive oral health services from non-dentist providers, i.e. primary care doctors and oral health professionals. Examples of covered oral health services include an oral health screening composed of an oral health history review, a physical examination of the child’s mouth, and referrals for preventive dental care or assessment and treatment, nutrition and tobacco counseling, oral hygiene instruction, fluoride application and fluoride varnish.

 

Better integration of primary medical care with dental care can help identify children at risk for tooth decay at the youngest age possible, offer evidence-based preventive care such as fluoride varnish and oral health education, and refer children to a dental professional for a complete check-up and any needed treatment. Three oral health risk assessment CDT billing codes can support this approach, potentially preventing the need for costly treatment, such as that provided in an operating room.—EPSDT-A Guide for States: Coverage for Medicaid Benefit for Children and Adolescents. U.S. Department of Health and Human Services. Centers for Medicare and Medicaid Services. June 2014. Pages 14-15.

 

Child and Teen Checkups (C&TC) is Minnesota’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program—a federal program required in every state to provide children enrolled in a Medicaid or public health insurance program with yearly well-child care health and dental visits.

Children eligible for Minnesota’s C&TC services include all children under the age of 21 enrolled in a Medicaid or Children Health Insurance (CHIP) expansion program (Medical Assistance) or MinnesotaCare (collectively called Minnesota Health Care Programs).

The following is based on data from the CMS-416 Report, which reports on children oral health measures such as non-dentist oral health service use among children:

  • Aged 1 to 20 years.
  • Enrolled in a Minnesota Health Care Program (MHCP) for at least 90 continuous days.
  • By federal fiscal year (October 1 through September 30).

A non-dentist oral health service is any diagnostic, preventive, or treatment service provided by a non-dentist such as a primary care doctor or oral health professional not under the supervision of a dentist.

Fluoride varnish application is an oral health service that can be provided by both a dentist and a primary care doctor. Fluoride varnish strengthens tooth enamel and can prevent cavities. MHCP pays for application of fluoride varnish once every six months in children (Minnesota Statutes 2018, chapter 256B.0625, subd. 9). For more information: About the Child and Teen Checkups Program (CMS-416) Report.       

1 in 10 C&TC eligible children receive at least one yearly non-dentist oral health service

Non-dentist oral health service use more than doubled from 5.9% in 2017 to 13.4% in 2018. A recent policy change resulted in fluoride varnish application added to the required C&TC schedule. 

 

 

1 out of every 10
C&TC eligible children (1 to 20 years)

 

(13.4%, 95% CI = 13.3 to 13.5; n = 78,831 of 587,857)

Have at least one non-dentist oral health service
FFY 2018


 

Non-dentist oral health service use among C&TC eligible children by age, federal fiscal year 2018

 
Source: Minnesota Department of Human Services. Early and Periodic Screening, Diagnosis, and Treatment (CMS-416) Report.
Age group (years) Number of C&TC eligible children Number of C&TC eligible children with at least one non-dentist oral health service Percent C&TC eligible children with at least one non-dentist oral health service within age groups (row percent) 95% Confidence Interval
Less than 1 26,080 5,433 20.8% 20.3 to 21.3
1 to 2 74,172 36,364 49.0% 48.7 to 49.4
3 to 5 100,214 31,285 31.2% 30.9 to 31.5
6 to 9 124,896 6,078 4.9% 4.7 to 5.0
10 to 14 147,338 3,613 2.5% 2.4 to 2.5
15 to 18 98,139 1,298 1.3% 1.2 to 1.4
19 to 20 41,800 193 0.5% 0.4 to 0.5

Data include Child and Teen Checkups (C&TC) eligible children enrolled in a Minnesota Health Care Program for at least 90-continuous days during the federal fiscal year (FFY) (October 1 through September 30). Total eligible children enrolled during FFY 2018 = 587,857. 

A non-dentist oral health service is any diagnostic, preventive, or treatment service provided by a non-dentist such as a primary care doctor or oral health professional not under the supervision of a dentist.  Data is based on all unduplicated counts of paid, unpaid, and denied claims submitted for reimbursement from fee-for-service providers, managed care plans, Indian Health Services, and Federally Qualified Health Centers that contract with the Minnesota Department of Human Services.  This chart represents percent non-dentist oral health service use within age groups (row percentages).  See About the Child and Teen Checkups Program (CMS-416) Report data for more information.

In federal fiscal year 2018, non-dentist oral health service use among C&TC eligible children increased more than two-fold in all age categories under 10 years.  

Children aged 0 to 5 years were almost 14 times more likely to receive a non-dentist oral health service than children aged 6 to 20 years.  


 

Non-dentist oral health service use among Child and Teen Checkups (C&TC) eligible children by race and ethnicity, federal fiscal year 2018

 
Source: Minnesota Department of Human Services. Early and Periodic Screening, Diagnosis, and Treatment (CMS-416) Report.
Race and ethnicity Number of C&TC eligible children
(1 to 20 years)
Number of C&TC
eligible children
(1 to 20 years)
with at least one
non-dentist oral health service
Percent C&TC
eligible children
(1 to 20 years)
with at least one
non-dentist oral health service within race and ethnicity groups (row percent)
95% Confidence Interval
African American or Black 80,630 11,775 14.6% 14.4 to 14.8
Asian or Pacific Islander 29,693 4,277 14.4% 14.0 to 14.8
Hispanic/Latino 34,777 4,602 13.2% 12.9 to 13.6
Two or more races 27,024 3,264 12.1% 11.7 to 12.5
White 193,059 18,729 9.7% 9.6 to 9.8
American Indian/Alaska Native 15,637 1,237 7.5% 7.5 to 8.3

Data include Child and Teen Checkups eligible children enrolled in a Minnesota Health Care Program for at least 90-continuous days during the federal fiscal year (FFY) (October 1 through September 30).  Total eligible children (1 to 20 years) enrolled during FFY 2018 with a known single race and ethnicity or mixed race = 380,820. Unknown or missing race and ethnicity (not shown in this chart) = 34,947 with at least one non-dentist oral health service out of 207,037 eligible. Two or more races = any combination of two or more single race and ethnicity.      

 

A non-dentist oral health service is any diagnostic, preventive, or treatment service provided by a non-dentist such as a primary care doctor or oral health professional not under the supervision of a dentist.  Data is based on all unduplicated counts of paid, unpaid, and denied claims submitted for reimbursement from fee-for-service providers, managed care plans, Indian Health Services, and Federally Qualified Health Centers that contract with the Minnesota Department of Human Services.   This chart represents percent non-dentist oral health service use within race and ethnicity groups (row percentages). See About the Child and Teen Checkups Program (CMS-416) Report data for more information.

Compared to federal fiscal year 2017, non-dental oral health service use doubled or nearly doubled among all racial/ethnic groups in federal fiscal year 2018. American Indian/Alaska Native children eligible for C&TC continue to have the lowest rate of non-dental oral health service use.  


 

C&TC eligible children (1 to 20 years) non-dentist oral health service use, federal fiscal year 2018

County map image Child & Teen Checkup Eligible Children (1 to 20 years) Non-Dentist Oral Health Service Use and link to PDF of the same
 

Child and Teen Checkups eligible children include all children enrolled in a Minnesota Health Care Program (Medical Assistance or Medicaid, MNCare) for at least 90-continuous days during the federal fiscal year (FFY) Oct. 1 through Sept. 30).  Total eligible children (1 to 20 years) enrolled during FFY 2018 = 587,857. A non-dentist oral health service is any diagnostic, preventive, or treatment service provided by a non-dentist such as a primary care doctor or oral health professional not under the supervision of a dentist. Data is based on all unduplicated counts of paid, unpaid, and denied claims submitted for reimbursement from fee-for-service providers, managed care plans, Indian Health Services, and Federally Qualified Health Centers that contract with the Minnesota Department of Human Services.  See About the Child and Teen Checkups Program (CMS-416) Report data for more information.

During federal fiscal year 2018, C&TC eligible children in Anoka County (17%) had the highest non-dental oral health service use and C&TC eligible children in Lake of the Woods County (0.0%) had the lowest non-dentist oral health service use. Some counties were statistically different from the statewide rate.