Dental and Vision Services
Access to needed dental and vision services, including preventative dental care, is an essential part of a well-functioning system of care for children and youth with special health care needs (CYSHCN). While EPSDT covers medically necessary dental and vision services for CYSHCN enrolled in Medicaid, Title V supports access to general dental services for many CYSHCN, including those who are enrolled in Medicaid, uninsured, or underinsured. Title V is often also involved in organizing orthodontic and specialty dental care, such as care for cleft palate, as children requiring these services benefit from a team-based approach to care.
According to the 2019-2020 National Survey of Children’s Health, 72.3% of CYSHCN had not received a vision screening in the past 12 months. Title V programs often collaborate with Medicaid, community partners, and schools to facilitate vision screening as part of EPSDT, and some CYSHCN programs also facilitate or financially support more in-depth vision care for children enrolled in their program.
General Dental Services
Many state Title V programs are engaged in providing general dental services to children, including CYSHCN. In Missouri, local public health authorities provide space for the provision of oral health services, and Title V funds dental hygienists who work around the state.
Local health departments in North Carolina and Illinois use Title V funds to provide dental services to children. In Illinois, Title V partners with the Oral Health Section (OHS) on several programs that emphasize the importance of oral health, including the Partnerships for Integrating Oral Health Care into Primary Care Program that focuses on integration of the interprofessional oral health core clinical competencies into primary care practice. Another key program of the partnership was the provision of dental sealants to children on Medicaid or without dental insurance.
Through the Department of Public Health, Iowa Title V provides funding to a statewide dental program called the I-Smile Dental Home Initiative that serves children and pregnant women. A related program called I-Smile School provides preventative dental care for school-age children.
Montana’s Title V Oral Health Program applied for and received federal funding under the Grants to States to Support Oral Health Workforce Activities program. The Oral Health Program employs a hub and spoke model of community dental programs that provide education on oral health and preventative services for children.
School Based Dental Programs
The Title V program in Kansas developed and implemented a fluoride varnishing and dental sealant program as part of the state’s oral health program. The program consists of about 10 dental hygiene clinics around the state with public health dental hygienists. These dental hygienists also provide services in schools. Similarly, Title V funds in Arizona, New York, Oregon, and Rhode Island financially support school-based dental sealant programs.
In Illinois, School Based Health Centers (SBHC) are supported with Title V funds and can offer dental services. IDPH School Health Program certifies and monitors 63 SBHCs across Illinois. SBHCs focus on improving the overall physical and emotional health of school-aged youth by promoting healthy lifestyles and providing accessible preventive health care. On site dental services are not a requirement for certification, but many SBHCs offer these services as access to oral health has been reported by families as a barrier to care. In FY21, there were an estimated 25,900 dental visits with 14,100 unique clients.
Florida used its Title V funds to expand its school sealant program; Florida Title V also supported the development of a public health dental program database that contains data on the reach of the school-based sealant program and other oral health surveillance.
Alabama’s CYSHCN program, Children’s Rehabilitation Services (CRS), is the primary provider of orthodontic services for children and youth enrolled in Medicaid. CRS administers a Craniofacial Orthodontia Clinic that provides orthodontic services for children with selected congenital and craniofacial abnormalities. To provide services, CRS contracts with an orthodontist who receives a monthly fee. Reimbursement of orthodontia services by the state Medicaid program finances this fee.
The Title V program in South Carolina sponsors orthodontic services for children with craniofacial conditions that lead to functional impairments of the face, jaw, mouth, or teeth. To be eligible for the program, the child must not have Medicaid or other dental coverage, and the family’s income must be below 250% FPL. The program will also pay for some routine dental services including check-ups and cleanings.
The Title V program in West Virginia has leveraged their partnership with the state Medicaid program to increase access to orthodontics by working with Medicaid to open additional billing codes for these services.
Specialty Dental Services
The Title V programs in Arkansas, Missouri, and North Dakota financially support dental services for children with specific and complex craniofacial conditions. Title V funds in Arkansas cover services for children with cleft lip and palate conditions, while Missouri uses Title V funds to cover cleft palate services. North Dakota’s Title V program for children and youth with special health care needs (CYSHCN), called Special Health Services (SHS), pays for services for conditions including ectodermal dysplasia, handicapping malocclusion, congenital dental abnormalities, and cleft lip and palate.
North Dakota’s Title V program administers cleft lip and palate clinics in the state. These clinics employ a pediatric dentist, plastic surgeon, and orthodontist.
Title V and Medicaid Partnering to Improve Oral Health
Utah’s state oral health program and dental director, who are partially funded with Title V dollars, encourage dentists around the state to accept Medicaid, especially for pediatric populations.
Utah Title V and Medicaid are working together on strategies to address emergency room visits for non-traumatic dental issues after a 2019 report showed that Medicaid and CHIP covered almost half of the charges.
Referring to Community Resources for Oral Health Services
The Title V programs in Louisiana and Missouri utilize care coordination services to provide families with information on accessing dental services. In Missouri, service coordinators routinely assess dental needs. In Louisiana, CYSHCN clinic staff and the Title V Family Resource Center also support families with linkage to dental services.
Mississippi Title V has close relationships with Federally Qualified Health Centers (FQHC) in the community, and they refer children and youth to FQHCs for dental care. The state employs oral health consultants around the state who conduct outreach with community members. The consultants’ activities include conducting oral health screening, providing education and guidance to health professionals and the public, conducting oral health prevention programs, and promoting the benefits of community water fluoridation.
The Title V program in Alaska created an information packet about oral health for CYSHCN. Stone Soup Group, the state’s Family-to-Family Health Information Center (F2F), disseminates the packet to families raising CYSHCN.
In Utah, Title V funds an oral health educator who provides education and referrals specifically to students in middle and high schools.
Dental System Surveillance
Mississippi Title V participates in the CYSHCN Cares 2 Learning Collaborative, which includes a focus on oral health. Through this initiative, Title V collects data on the number of CYSHCN with a dental home and the number who are referred to annual dental visits.
The Title V program in Vermont noticed that Title V was paying for some orthodontic services expected to be covered under the state Medicaid program. Title V worked with Medicaid to ensure that medically necessary dental services were covered under EPSDT. Title V also helps families navigate coverage and benefits for dental services.
In West Virginia, the CYSHCN and oral health programs are co-located and work closely together. They are working on including dental care in the comprehensive care plan and ensuring that appropriate screening, diagnosis and treatment happen related to oral health.
The Title V program in New York collects data from 52 county based CYSHCN programs, including data on dental insurance enrollment.
Oral Health Workforce
North Carolina Title V employs two part-time dental hygienists as part of a dental home initiative. The hygienists provide education to dentists about treating CYSHCN in order to improve access to services.
The Title V program in Alaska received funding from HRSA related to the oral health workforce. With these funds, Alaska Title V hired a consultant to develop and implement a plan to address the needs of the oral health workforce. The oral health program in Alaska also works with the tribal health system to implement a dental health aide program.
Virginia’s Title V program administers an oral health program for CYSHCN. The program informs dental care providers and families about dental care for CYSHCN and maintains a list of dental providers who serve CYSHCN. The state received a CDC oral health grant in 2019 through which they surveyed individuals with special health care needs about oral health needs. The results of the survey informed the development of oral health services and programs.
In July of 2020, Louisiana’s Title V program successfully transitioned all children served through the Title V funded ophthalmology clinic to community providers. Children who meet the criteria for CYSHCN and require ophthalmology services are now referred to their Medicaid Managed Care Organization or the Louisiana Title V Family Resource Center for linkage to an ophthalmologist that accepts their insurance.
The Title V program in Indiana has a small budget to fund vision services for children aged 0-3 if the services are not related to any other health condition. Similarly, in North Carolina, Title V has funds for uninsured children through the organization Prevent Blindness NC.
The Title V program in Tennessee covers vision services related to a qualifying condition to children enrolled in the CYSHCN program.
Similarly, The Title V program in New Mexico covers vision services for specific conditions only for children in the CYSHCN program.