Millions of Medicaid Children Left without Required Dental Care

New Report of January 27,2016 from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) provides information that millions of children enrolled in Medicaid in California, Indiana, Louisiana and Maryland are not getting required dental care.  This is due to shortages of participating dental providers and the challenges associated with educating families as to the importance of regular care.


From Theresa Pablos, assistant editor, the following excerpt:


While visiting a dentist is crucial to maintaining optimal oral and overall health, millions of children enrolled in Medicaid have trouble getting dental care. This sometimes has drastic consequences, as was the case for a 12-year-old boy in Maryland who died after his family could not find a Medicaid dentist to treat his tooth pain, the report noted.

The HHS specifically chose California, Indiana, Louisiana, and Maryland, because those four states adopted the periodicity schedule from the American Academy of Pediatric Dentistry (AAPD), which suggests children receive oral services at a minimum of every six months. Combined, the four states serve nearly 20% of all children enrolled in Medicaid.

The most prominent report finding was that an average of 78% of children did not receive the dental care required by EPSDT. The exact percentage varied among the four states, with a high of 81% of Louisiana kids not receiving the required care and a low of 73% of kids in Maryland.

The researchers also found that 28% of children, more than 1 million children in the four states, did not receive any dental care between 2011 and 2012. An additional 14% of children only had one dental visit during the same time period.

Other report findings include the following:


  • Children ages 3 and younger were the least likely age group to receive dental care.
  • 86% of children who received all required dental care visited the same practice throughout the two years.
  • Two states (unnamed in the report) had payment policies that conflicted with their required schedules.
  • All four state officials noted a key barrier to dental care for Medicaid children was a lack of providers, typically because of low reimbursement rates or administrative burdens.


CMS has already reviewed the recommendations in the report, agreeing partially or fully with all but one recommendation — work with states to track children’s utilization of required dental services. The recommendation specifically points out that the data being collected by CMS’s Form 416 does not provide enough important information, but CMS disagreed.

“We recognize that CMS has already taken some steps toward addressing the issues we found in this report. It has developed materials to educate consumers and providers about positive oral health practices, and it has shared strategies with states to improve access to and utilization of dental care,” Murrin concluded. “However, we continue to have concerns that children are not receiving required dental services.”

The complete article can be found at


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