135 - Medicaid Payment Policies and Minimally Invasive Pediatric Dentistry Adoption

Abstract:

Background: Minimally invasive (MI) dental techniques for pediatric caries management can improve access and equity. However, Medicaid payment policies, which are critical for low-income children, often fail to align with these evidence-based approaches, creating a primary barrier to dissemination.

Methods: We conducted a policy analysis integrating a structured review of state Medicaid dental provider manuals and fee schedules (FY 2023-2024), peer-reviewed literature on MI adoption, and financial models from safety-net clinic networks. We focused on four MI techniques: Silver Diamine Fluoride (SDF), Atraumatic Restorative Treatment (ART), the Hall Technique, and teledentistry.

Results: Substantial variability exists in Medicaid payment recognition for MI techniques across states. Adoption is highest where policies provide explicit coding and adequate reimbursement. For example, states with SDF reimbursement rates above $50 per application report significantly higher utilization in Federally Qualified Health Centers (FQHCs). Conversely, policies requiring the use of traditional restoration codes for ART or failing to recognize equivalent reimbursement for teledentistry suppress provider adoption and limit patient access.

Conclusion: Strategic payment reform is necessary to translate clinical evidence into population health. Recommendations include establishing equitable fee-for-service rates for MI codes, developing bundled payment pilots for caries management, and mandating permanent teledentistry reimbursement parity to reduce geographic and economic disparities in dental care.

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