Transforming Medicaid & CHIP: What It Means for Kids’ Oral Health
Back in February 2020, just before the world turned upside down due to the coronavirus pandemic, a whopping 71 million individuals were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). Fast forward to May 2023, and as the national Covid-19 Public Health Emergency (PHE) officially came to an end, millions found themselves grappling with the loss of their Medicaid and CHIP coverage. This upheaval was catalyzed by the eligibility renewal process known as Medicaid redetermination, which assessed household incomes and healthcare benefits, sparking a significant shift in the healthcare landscape across the nation.
To truly understand the gravity of this situation, let’s revisit the peak enrollment numbers. National Medicaid and CHIP enrollment soared to an astonishing 94.5 million in April 2023, just one month before continuous enrollment came to a halt. That’s an increase of 23.1 million enrollees or a staggering 32.4% from February 2020. Remarkably, during this period, enrollment among adults surged by 45%, while child enrollment grew by a more modest 20%.
As of June 2024, approximately 79.9 million Americans are still benefiting from Medicaid and CHIP plans, with children making up nearly half (47%) of that total. However, between May and June 2024, we witnessed a concerning 17% decline in enrollment. One key factor may be the new federal rule that took effect in June, mandating states to ensure a seamless transition for enrollees between Medicaid and CHIP when their eligibility changes. Unfortunately, many children who lost coverage might still qualify for CHIP but may have been overlooked due to paperwork mishaps or states not automatically transferring enrollees between programs.
From a state perspective, most have wrapped up the redetermination process with a higher total enrollment than they had in February 2020. Seven states even reported enrollment levels soaring by at least 30%. Conversely, Texas, Florida, Georgia, and California experienced the largest drops in child Medicaid and CHIP enrollment, accounting for half of the national decline. Texas alone saw a staggering loss of over a million enrolled children, with Florida, Georgia, and California following closely behind.
With the redetermination largely in the rearview mirror, the Centers for Medicare & Medicaid Services (CMS) have voiced serious concerns about the significant disenrollment during this transition, particularly for the well-being of children.
Why Oral Health Matters
In the United States, about 38% of children aged 0-18 access dental benefits through Medicaid or CHIP. Unlike adult coverage, states are required to provide dental benefits to children under these programs. At a minimum, Medicaid mandates coverage for essential dental services aimed at alleviating pain, treating infections, restoring teeth, and promoting overall dental health.
For families hovering just above the Medicaid income threshold, CHIP is a vital lifeline, helping to prevent diseases, promote oral health, restore dental function, and address urgent conditions. Medicaid and CHIP not only facilitate access to essential oral health services but also bridge the gaps for children from low- and moderate-income families, ensuring that their socioeconomic status doesn’t dictate their access to necessary dental care.
The federal government has recognized the critical link between oral health and overall physical well-being, leading to new mandates. Starting in 2024, states will be required to report on the Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP. These measures will focus on vital services such as oral exams, fluoride treatments, and dental sealants.
In September 2024, CMS rolled out comprehensive guidance aimed at ensuring that the 38 million children enrolled in Medicaid and CHIP – nearly half of all children in the U.S. – receive the full spectrum of healthcare services they require. This guidance, part of Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) initiative, guarantees that eligible children and youth have access to a comprehensive array of preventive, diagnostic, and treatment services—including regular check-ups, mental health resources, dental care, and vision and hearing services. These robust requirements are designed to ensure early detection and treatment of health issues. Thanks to EPSDT, Medicaid offers one of the most extensive health coverage plans available for children and youth in the country.
This guidance marks the most thorough EPSDT update in a decade, and it’s a commendable step forward.
What’s at Stake for Our Kids
The healthcare landscape in America is shifting, especially in an election year. But let’s keep our focus where it belongs—on the health of our children.
CMS has stated that poor oral health can severely impact children’s quality of life, academic performance, and future success. Yet, disturbingly, nearly half of all American children do not receive regular dental care. Even more alarming, only 18% of dentists serve over 100 children annually who have Medicaid coverage, while a staggering 67% treat none at all.
Over the past two decades, we’ve recognized that social determinants of health (SDOH)—like socioeconomic status and race—play a vital role in children’s oral health. Approximately half of American children face barriers to regular dental care due to these factors. Vulnerable populations tend to have less access to oral health services and typically suffer from higher rates of dental issues. Notably, children with special needs have seen slower progress in accessing dental care, partly due to a lack of training among dental professionals to manage complex conditions.
Children’s health transcends political lines; it’s a vital call to action for all states to enhance Medicaid and CHIP resources, particularly concerning dental care. By expanding access to these services, ensuring continuity of care, reducing disparities, and facilitating cost-effective preventive measures, we can significantly enhance the health and development of our most vulnerable children.
To cultivate a nation filled with bright, healthy smiles, we must prioritize and adequately fund oral health on par with physical health. Access to proper dental care is essential in breaking down the barriers that continue to exist nationwide, especially in marginalized communities where the need is most acute.
Photo: Tom Werner, Getty Images
