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Other
Hanan M. AbdelGilil, B.S, DDS Candidate
Student
University of Texas Health Science Center-Houston
University of Texas Health Science Center at Houston
Houston, Texas, United States
Priyanshi Ritwik, DDS, MS
Professor
UTHealth Houston School of Dentistry
University of Texas Health Science Center Houston School of Dentistry
Houston, Texas, United States
Bhavini Acharya, BDS
Pediatric Dentistry Graduate Program Director
University of Texas Health Science Center-Houston
Houston, Texas, United States
Purpose: This pilot project assessed the variations in state Medicaid criteria for eligibility for dental treatment for pediatric patients under general anesthesia (GA).
Methods: The Medicaid websites for ten states were accessed to ascertain the eligibility criteria for dental treatment under GA. The search was performed for CDT codes D9420, D9220, D9230. The websites were also explored to name and enumerate the number of managed care organizations (MCOs) that disburse Medicaid dental benefits to pediatric recipients in the respective states.
Results: The Medicaid criteria and MCOs were extracted from the websites in ten states. These states were selected due to dental schools in these states participating in the BigMouth Consortium. Through evaluating the eligibility criteria, it was found that the eligibility criteria are not uniform, with some states having inflexible point systems for eligibility versus others needing a narrative for prior authorizations. The state dental Medicaid plans partner with varying number of MCOs, ranging from 2 to 20 MCOs.
Conclusions: Access to dental treatment under general anesthesia (GA) for children presents significant challenges. Barriers such as limited availability of hospital-based dental services, long waiting times, high costs, and insurance limitations hinder timely care. The different eligibility “criteria” for dental treatment under GA that vary state by state and the numerous MCOs that providers need to credential with and process prior authorizations add an additional layer of complexity and barriers to access for this important service for vulnerable children.