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Sample Purchasing Specifications for Medicaid Pediatric Dental and Oral Health Services

Using the Medicaid Managed Care Contracting Process to Improve the Dental and Oral Health of Low-Income Children

The conversion of many state Medicaid programs to managed care offers important opportunities to address chronic shortfalls in essential dental and oral health care for Medicaid-eligible children. In some states, these children do not receive basic dental services that could prevent costly treatment of unnecessary cavities and the threat of infection and acute pain from untreated tooth decay. Medicaid managed care organizations (MCOs) can assume responsibility for ensuring that children who are Medicaid beneficiaries receive routine oral health screenings and prevention and treatment services.

A policy tool has been developed that uses the managed care contracting process to improve the oral health of Medicaid children. Sample Purchasing Specifications for Medicaid Pediatric Dental and Oral Health Services* is available without charge at the George Washington University Medical Center Web site. These voluntary purchasing specifications address the basic scope and amount of dental and oral health services for children, allowable limitations and exclusions, and individual determinations of coverage. They reflect recognized principles of pediatric dental and oral health and statutory and regulatory standards for these services under the Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program.

The Specifications may be used either in whole or in part by Medicaid agencies in purchasing managed care services for Medicaid children. They are also appropriate for State Children’s Health Insurance Program (SCHIP) purchasing, employers, employer-purchasing coalitions, and other public health agencies that are developing or revising agreements with MCOs to provide health services for low-income and vulnerable subscribers.

The document was developed by the legal and public health staff at the George Washington University Center for Health Services and Health Policy Research (CHSPR). In drafting the specifications, CHSRP attorneys reviewed national guidelines for pediatric dental and oral health, peer-reviewed publications, and federal Medicaid law. Draft versions were reviewed by selected state Medicaid officials, representatives of professional dental associations, the managed care industry, state public health agencies, the Health Resources and Services Administration (HRSA), the Health Care Financing Administration (HCFA) and other interested federal agencies.

Staff attorneys at CHSRP are available to provide technical assistance to state Medicaid agencies, provider groups, public health agencies, and others who wish to adapt the sample specifications to policy preferences within individual states.

The Centers for Disease Control and Prevention (CDC), which supported the specifications project, provided technical assistance to CHSRP attorneys who drafted the document. As a CHSRP publication, however, the specifications do not represent official CDC policies.

* Links to non-Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organization Web pages found at this link.