Director of the Research and Policy Center American Academy of Pediatric Dentistry University of North Carolina
Disclosure(s):
Chelsea Fosse, DMD, MPH: No financial relationships to disclose
Abstract:
Objective: The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit requires that state Medicaid agencies (SMAs) facilitate the provision of comprehensive health care services – medical, dental, hearing, and vision – for children enrolled in Medicaid up to the age of 21. In September 2024, CMS issued a letter reminding SMAs that EPSDT also requires SMAs to “develop or adopt a dental periodicity schedule in consultation with recognized dental organizations in child health.” Periodicity schedules serve as invaluable resources for communicating to both enrolled members and participating providers about the services – at a minimum – for which members are eligible to receive and providers can be paid.
Methods: The Research & Policy Center (RPC) of the American Academy of Pediatric Dentistry (AAPD) scoured SMAs’ and contractors’ websites to ascertain current compliance with this EPSDT requirement, locating each state’s periodicity schedule (when available) and cataloging those details.
Results: Nine states have yet to adopt or develop a dental-specific periodicity schedule. Twenty states have adopted the AAPD periodicity schedule, and 22 states use a state-specific periodicity schedule.
Conclusions: In addition to urging these 9 states not in compliance with this EPSDT requirement to designate a dental periodicity schedule, there are other opportunities for improvement for SMAs to consider: make the schedules available directly from Medicaid and from any third-party contractors; make schedules readily accessible in any and all relevant chapters/sections of Medicaid materials (consumer website, dental manual, EPSDT manual, etc.); and incorporate state-specific dental needs of children into the schedule.
