Target populations

Children

  • Medicaid provides dental benefits to over 287,000 covered children as of July 2010.  However, only 41% of the covered children see a dentist each year.
  • Fluoride varnish was added as a Medicaid benefit for kids in 2009.  Dentists, as well as trained physicians and other providers can apply the varnish to a child’s teeth to prevent decay, and can bill for the service.
  • Dental providers for Medicaid kids include Community Health Centers, other safety net dental clinics, private dental offices, and national dental chains/franchises.
  • While reimbursement rates to dentists were increased in 2008 to 52% of commercial rates, they were again reduced in 2009, 2010 and 2011 by a total of 6.5%.
  • The Child Health Plan (CHP+) provides dental benefits for over 69,000 kids as of July 2010.  However, the benefit is capped at $600/year.  For 10% of the kids, this is not enough to meet their dental needs.

Pregnant Women

  • Medicaid does not cover preventative care and for 17,000 covered pregnant women (up to 133% of FPL).  Medicaid will cover very limited dental care if a patient has an oral condition that is exacerbating a concurrent medical condition and the provider obtains prior authorization.  Pregnancy may be considered an exacerbating condition.
  • About 7% of pregnant women on Medicaid seek dental care each year.
  • The 1,600 pregnant women covered by CHP+ (up to 250% of FPL) do not have dental coverage.
  • Recent research shows a probable link between poor oral health and pre-term births and a definitive link between dental caries in a mother and the transmission of dental disease to her child(ren).

Low-Income Adults

  • Medicaid does not cover dental care for adults in Colorado, unless they have an oral condition that is exacerbating a concurrent medical condition and the provider obtains prior authorization.
  • Recent research indicates a link between poor oral health and a variety of systemic conditions including heart disease, diabetes, and even Alzheimer’s Disease.
  • The Dental Lifeline Network (formerly known the Foundation of Dentistry for the Handicapped) receives a small amount of state funds to provide dental services to persons with disabilities.

Seniors

  • Funding of $600,000 for the Dental Assistance Program for Low-Income Seniors was cut in 2010.
  • Medicare does not have a dental benefit, though extractions can be covered in some circumstances.