Chelsea Fosse

People with intellectual and developmental disabilities (IDD) and their families and caregivers are faced with navigating two very different delivery and financing systems in dentistry: one during childhood and the other—often very disjointed—in adulthood. Even in states that offer Medicaid dental coverage for adults, the services are often substantially reduced, and the provider base to find a dentist is drastically diminished. Pediatric dentists encounter difficulty finding colleagues willing to take on the care of their patients with IDD as they reach adulthood. As a nation, we prioritize the health and wellbeing of children with disabilities via Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. By not establishing this bar of coverage through adulthood, U.S. policy limits the return on investment of EPSDT not only fiscally, but more importantly, in the health and quality of life of people with IDD as they progress into adulthood. Here we review policy prospects in disability services and dental care that could improve the transition experience and outcomes for patients, families, and providers. Within the disabilities realm, policies related to Home and Community Based Services, Long‐Term Services and Supports, Dual‐Eligible Special Needs Plans, HEADs UP Act, and EPSDT extension for IDD are considered. Dental policy opportunities explored relate to code development for transition implementation, quality measurement, and building upon existing clinical support tools for transition implementation. We assess the variety of stakeholder support and other inputs necessary and describe opportunities and challenges with our current day political environment.

Objectives: Individuals with disabilities experience greater barriers accessing health care services and have poorer oral health outcomes than those without disabilities. The aims of this study were to examine dental access, utilization, expenditures, and sources of payment between adults with intellectual disabilities (ID), other types of disabilities, and without disabilities.Methods: Secondary analyses of data from the 2017 Medical Expenditure Panel Survey (MEPS) allowed examination of dental access (being able to get dental care and receiving necessary dental care without delay), dental utilization (having a dental visit in the past year), total dental expenditures, and associated sources of payment between three groups of adults based on disability status using descriptive, bivariate, and multivariable statistics.Results: Adults with ID have 2.70 (95% CI: 2.03, 3.61) times the odds of being unable to get dental care and 2.88 (95% CI: 2.11, 3.94) times the odds of having to delay necessary dental care compared with adults without disabilities. No significant differences were observed in dental utilization or mean total dental expenditure between the three groups after adjusting for demographic and socioeconomic variables. Among adults who incurred a dental expenditure, adults with ID had a greater share of dental care paid for by Medicaid, and adults without disabilities had a greater share of dental care paid for by private insurance.Conclusions: Despite similar mean total dental expenditures, reduced dental access reported by adults with ID suggests that this population experiences significantly greater challenges obtaining dental care. Adults with ID rely more heavily on Medicaid to finance dental care.

Objectives: Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) pediatric benefit is designed to meet children’s medically necessary needs for care. A 2018 Centers for Medicare & Medicaid Services (CMS) Bulletin advised Medicaid programs to ensure that their dental payment policies and periodicity schedules include language that highlights that medically necessary care should be provided even if that care exceeds typical service frequency or intensity. We assessed the extent to which Medicaid agencies’ administrative documents reflect EPSDT’s flexibility requirement. Methods: From August 2018 through July 2019, we retrieved dental provider manuals, periodicity schedules, and fee schedules in all 50 states and the District of Columbia; analyzed these administrative documents for consistency with the CMS advisory; and determined whether instructions were provided on how to bill for services that exceed customary frequencies or intensities. Results: Dental-specific periodicity schedules were not evident in 11 states. Eighteen states did not include flexibility language, for example, as advocated by the American Academy of Pediatric Dentistry. Flexibility language was not evident in 24 dental provider manuals or in 47 fee schedules. Only 8 states provided billing instructions within fee schedules for more frequent or intensive services. Conclusion: Updating Medicaid agency administrative documents—including dental provider manuals and periodicity and fee schedules—holds promise to promote individualized dental care as ensured by EPSDT.