134 - Impact of Medicaid Dental Policy Reforms on Pediatric Access

Abstract:

Purpose: Medicaid’s EPSDT benefit guarantees dental coverage for children, yet caries prevalence and unmet needs remain disproportionately high among low‑income populations. Recent state revisions to benefit scope, reimbursement levels, and administrative requirements may influence provider participation and pediatric utilization of preventive and operative dental services.

Methods: This review synthesized peer‑reviewed literature, national policy analyses, and state plan documents. The evaluation focused on benefit scope, including minimally invasive services such as silver diamine fluoride (SDF) and anesthesia, reimbursement adequacy, provider participation, and trends in preventive visits and emergency department (ED) utilization. Four states (NY, PA, CA, TX) were selected as case examples to illustrate contemporary policy approaches and implementation details.

Results: States that reimburse minimally invasive pediatric services, clarify clinical criteria, and maintain consistent payment policies generally demonstrate increased preventive dental utilization. ED use varies depending on program design and availability of community‑based alternatives. Provider participation remains highly sensitive to reimbursement rates and administrative complexity. SDF policies increasingly specify frequency limits, lifetime caps, and documentation requirements, supporting broader adoption of conservative care.

Conclusions: Aligning reimbursement with chair time and procedural complexity, standardizing core pediatric dental benefits, including SDF and medically necessary anesthesia, and promoting incentives tied to minimally invasive, quality‑linked metrics may improve access and utilization. Targeted policies addressing children with special health care needs and rural populations can reduce disparities. Long‑term sustainability is achievable when benefit design reduces avoidable ED visits and lowers reliance on high‑intensity operative care.

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