At the federal level, CMS oversees Medicaid, which provides health care  coverage for low-income families and aged, blind, and disabled people. CMS oversight includes monitoring state Medicaid programs, issuing  guidance to states, and facilitating communication and collaboration  among stakeholders. CMS did not complete this initiative. State Medicaid Programs Reported They Employ Multiple Strategies to Monitor and Improve Access to Medicaid Dental Services, but Problems Persist

In response to our survey, most states reported using multiple strategies to  monitor and improve access to Medicaid dental services, but they also  reported that persistent barriers hinder improvements. All 21 states that  provided Medicaid dental services under managed care arrangements  reported that they set measurable access standards for MCOs, however  more than half also reported that MCOs in their state do not meet any, or  only meet some, of the state’s dental access standards. Almost all states described initiatives to recruit dental  providers and enhance outreach to beneficiaries’ families, but barriers  persist and access rates remain low. State Medicaid Programs Reported Efforts to Improve Access, but Also Reported That Persistent Barriers Hinder Further Improvement in Children’s Access to Dental Care

Many of the 51 states we surveyed reported efforts to improve children’s  access to dental care, including efforts to provide outreach to the families  of children in Medicaid and recruit dental providers. For example, one state  Medicaid program implemented an initiative that included simplifying  claims processing, increasing reimbursement rates, educating and  recruiting providers, and educating beneficiaries. CMS Has Taken Action to Improve Federal Oversight of State Medicaid Dental Services for Children, but Gaps Remain

Responding to congressional concern about CMS oversight of state  Medicaid dental services, CMS has taken a number of actions since May  2007 to strengthen its oversight of Medicaid dental services for children,  but gaps remain in the agency’s efforts. At the time of our review, some of these initiatives had been  completed, while others were still under way. Although CMS and states have taken  steps to address long-standing barriers, continued attention and action is  needed to ensure children’s access to Medicaid dental services. Recommendations for Executive Action

To strengthen monitoring of state Medicaid dental services for children  and help states improve children’s access to Medicaid dental services, we  are recommending that the Administrator of CMS take the following four  actions:    Develop a plan to review dental services for Medicaid children in all states  with low utilization rates, such as those not meeting HHS’s Healthy People  2010 targets.
Why GAO Did This Study

Children's access to Medicaid dental services is a long-standing concern. The tragic case of a 12-year-old boy who died from an untreated infected tooth that led to a fatal brain infection renewed attention to this issue. He was enrolled in Medicaid--a joint federal and state program that provides health care coverage, including dental care, for 30 million low-income children--but, like many children in Medicaid, he experienced difficulty finding a dentist who would treat him. At the federal level, the Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), oversees Medicaid. In this report, GAO examined (1) state strategies to monitor and improve access to dental care for children in Medicaid and (2) CMS actions since 2007 to improve oversight of Medicaid dental services for children. GAO surveyed all state Medicaid programs and interviewed state and federal officials, and dental researchers and associations

What GAO Found

State Medicaid programs reported that they use multiple strategies to monitor and improve access to dental services for children, but problems persist. Most states responding to our survey use a variety of tools, such as examining claims and utilization data, to monitor the provision of dental services to children in Medicaid. Although all 21 states that provide Medicaid dental services through managed care organizations (MCO) reported that they set measurable access standards for MCOs, 14 states reported that MCOs do not meet all of the state's dental access standards. Almost all states described initiatives to improve access to dental services, including simplifying claims processing, increasing reimbursement rates, recruiting providers, and educating beneficiaries. Nonetheless, access rates remain low and states reported that long-standing barriers hinder further improvement. Since May 2007, CMS has taken steps to strengthen its oversight of Medicaid dental services for children, but gaps remain. For example, CMS reviews of Medicaid dental services in 17 states identified a number of concerns and made recommendations for improvement. Nonetheless, at the time of our review CMS did not plan to perform more reviews, even though other states had utilization rates well below HHS's 2010 target for low-income children receiving a preventive dental service. CMS also provided guidance to states and facilitated collaboration among stakeholders, but states reported needing more CMS support, including guidance on setting dental payment rates, on quality initiatives, and on promoting outreach. States also reported wanting more information on other states' efforts to improve dental utilization.