Purchasing Specifications for Medicaid Pediatric Dental and Oral Health
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
A new 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
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.
Page last reviewed: June 1, 2007
Division of Oral Health,
National Center for Chronic Disease Prevention and