The Full Restoration of Adult Dental Benefits and How it Impacts Pregnant Women and Children

MONICAOCHOA,MPHORALHEALTHADVOCACYCOORDINATORMATERNALANDCHILDHEALTHACCESSCPHENHEALTH INTEGRATIONFORUMFEBRUARY8, 2018

MaternalandChildHealthAccess(MCHA)improvesthehealthoflowincomewomenandfamiliesthroughadvocacy,education,

traininganddirectservices.

FullRestoration

Existing:§ ExamsandX-rays§ Cleanings§ Fluoridetreatments§ Fillings§ RootCanalsinfrontteeth§ Prefabricatedcrowns§ FullDentures§ Denturesrelines

New:

§LaboratoryProcessedCrowns

§RootCanalsinBackteeth

§Partialsdentures

§Partialdentureadjustments,repairsandrelines,

§Periodontics(scalingandrootplanning

OnJanuary1,2018,adultswithfullscopeMedi-Calbecameeligibleforfullrestorationofdentalbenefits.

LettermailedouttoMedi-Cal

beneficiaries

Pregnantwomenandthefullrestoration“Dental benefits will not change for pregnant women or adults in a skilled nursing or intermediate care facility”.

AllpregnantwomenintheMedi-Calprogramareeligibleforthefullyrestoredbenefits.InANYaidcode:

• Fullscope• Restricted• PresumptiveEligibility• Pregnancy-only

ProviderManualSection4- Pregnancy-RelatedServices

EffectiveOctober1,2014,pregnantbeneficiaries,regardlessofage,aidcode,and/orscopeofbenefitswillbeeligibletoreceivealldentalprocedureslistedintheDenti-CalManualofCriteria(MOC)thatarecoveredbytheMedi-CalprogramsolongasallMOCprocedurerequirementsandcriteriaaremet.Beneficiarieswillalsobeeligibletoreceivetheseservicesfor60dayspostpartum,includinganyremainingdaysinthemonthinwhichthe60thdayfalls.

BenefitsQuick

ReferenceGuide

Thischartconveysthefullrestorationinasimpleandstraightforwardmanner

The 2013 utilization rate for Los Angeles County is 14.6 for pregnant women who received a pregnancy related medical service and a pregnancy related dental service.

Wedonothavecomprehensiveutilizationdataforpregnancy

Wecanonlyobtaindatafrompregnancyonlyaidcodes

Welackdatafromnon-pregnancyaidcodes

Informationfromwomenwhovisitthedentistduringtheirpregnancyisnotquantified(notcapturedontheclaimform)

Howmanypregnantwomenactuallyvisitthedentistwhatthedatatellsus…andwhat'smissing

PregnancyisaTeachableMomentWhat happens when a woman accesses dental care (and now the fully restored benefits) during pregnancy?

• Resultsinahealthierpregnancy• Bettermaternal-childoutcomes• Lowerstheoraldiseasethatcanbetransmittedfrommothertochild

• Reducesearlychildhoodcaries• Momstartstovieworalhealthasanintegralpartofoverallhealth

• Shebeginstotakeontheroleofamaincare-giver

Impactonthefamily• Vieworalhealthasanintegralpartofoverallhealth

• Decisionmakers• Ensurethattheirchildrenmisslessschooldaysduetodentalpain

• Arethecenteroftheirimmediateandextendedfamilyandcaninfluencethemondentalutilization

• Whenamomvaluesoralhealth,shepassesthatimportanceontoherkidsandfamily

IntegrationandMultipleEngagementPoints

Families need numerous reminders from different agencies; • Eligibility or social worker, • Primary care providers, schools, • Home visitors, • Faith-based organizations, • WIC offices, • At health fairs • etc…

MCHAoralhealthprogrammaticandpolicyworkMCHAhasbeenincreasingaccesstooralhealthresourcesandutilizationthrough

• Casemanagement

• Medi-Calenrollment

• Grantsandfundingfororalhealthadvocacywork

• Homevisitationprogramstoaskaboutdentalcareandprovideresources

• Trainingaboutdentalbenefitsandpolicies

• Policyandadvocacyworkatthestateleveltoincreaseaccesstocareforpregnantwomen

• HostandconvenetheLAStakeholdermeetingswithDHCS

WelcomeBaby- largesthomevisitationpilotprojectinLosAngeles

Whenthepilotwasintheinitialplanningphases,MCHAadvocatedfordentalquestionstobeapartoftheintake.

WB2017PrenatalIntake-DentalQuestionsDentalInsurance Number PercentDenti-Cal 659 96%PrivateDentalCoverage 18 3%NoDentalInsurance 7 1%

AtIntake:DentalExaminpast12months? Number PercentYes 321 47%No 365 53%TotalPrenatalEnrollments 686 100%

Resources•MCHAwebsite– www.mchaccess.org

•https://www.cdafoundation.org/portals/0/pdfs/poh_guidelines.pdf

OralHealthDuringPregnancyandEarlyChildhoodGuidelines

•https://www.mchoralhealth.org/

NationalMaternalandChild

OralHealthResourceCenter

Educateothersandadvocate,attendstakeholdermeetings,documentgapsandbarrierstocare

Questions and contact informationMonicaOchoa,MPH

OralHealthAdvocacyCoordinatorMaternalandChildHealthAccess1111WestSixthStreet,FourthFl.

LosAngeles,CA90017213– 749-4261

monicao@mchaccess.org