Dental Information

The Department of Public Welfare (DPW) is committed to improving access to and utilization of dental services for Pennsylvania’s most vulnerable citizens. Collaborative relationships are an essential component of any successful campaign that strives to initiate a positive change in the community. As part of DPW's commitment to improving access to quality dental care for MA recipients, DPW is dedicated to continuing to build productive working relationships with stakeholders and advocates.

The content on this portion of the dental services section of this Web site provides stakeholders and advocates with valuable information about dental services provided in the MA program, Pennsylvania dental statistics, recent improvement initiatives, past and present outreach efforts and helpful links.

Dental Services Provided in the Medical Assistance Program:

The scope of benefits for which MA recipients are eligible differ according to recipients’ categories of assistance. MA covers the following:

All medically necessary dental services for children under age 21 enrolled in MA.

Categorically needy individuals 21 years of age or older are eligible for all medically necessary dental services. Families with children who are eligible for MA and who meet the financial eligibility requirements for TANF, SSI or an optional State supplement are also defined as categorically needy. These services include diagnostic (exam & x-rays), preventive (prophys), restorations (amalgam and composite restorations), extractions, other types of oral surgery, complete and partial dentures, root canals and crowns.
Dental services are also provided for medically needy only adults for palliative treatment or if the condition of the patient requires services be provided in a short procedure unit (SPU), ambulatory surgical center (ASC) or inpatient hospital.
Beneficiaries in nursing homes and ICF-MR Facilities are afforded the same coverage as adults. For additional information on covered services, refer to the Pennsylvania Code, Medical Assistance Manual.

For additional information on covered services, refer to the Pennsylvania Code, Medical Assistance Manual.

Useful Statistics And Data:

According to the Pennsylvania Department of Health, more children are affected by dental decay than asthma. In Pennsylvania, tooth decay affects 48 percent of children by the age of eight. By age 15, this percentage increases to 50 percent. In low-income households, 33 percent of children have untreated tooth decay, in comparison to only ten percent of children in higher-income households. Like most other states, Pennsylvania is currently working to address several dental care delivery challenges. Pennsylvania’s challenges stem from the following factors:

Demographics
- Pennsylvania has the sixth highest state population, with 12.3 million residents.
- Pennsylvania has a significant number of residents under age 19 (25 percent).
- Pennsylvania has 2.8 million rural residents. Rural residents account for approximately 23 percent of Pennsylvania's population.
- Pennsylvania has almost 1.4 million MA recipients that are eligible for dental care. In 1996, approximately 1.1 million MA recipients were eligible for dental care.1

Oral care workforce
- Fifty-five areas in Pennsylvania are experiencing a shortage of dental professionals.
- Thirty-one percent of dental professionals in Pennsylvania are between the ages of 50-60. Twenty six percent of the dental professionals are between the ages of 30-40. From 1999 to 2001, the number of licensed dentists has decreased by 700.

Oral disease prevalence
- There were 1,370 diagnosed cases of oral cancer and 356 deaths attributed to oral cancer in 1997 in Pennsylvania.
- Children in households with an annual income of less than $20,000 in Pennsylvania are three times more likely to have untreated dental caries than children in households with an annual income of more than $100,000.

Non-fluoridated water systems
- Approximately 85 percent of Pennsylvania residents get their water from Community Water Systems.
- More than half of the population in Pennsylvania does not have fluoridated water.

Pennsylvania Department Of Public Welfare Dental Summit:

As part of its effort to address key issues facing the oral health of MA consumers, DPW has hosted two Dental Summits attended by health plans, consumers, advocates, providers and other stakeholders. These gatherings have generated a clear understanding of the dental issues Pennsylvania is confronting and have provided many ideas about how to improve the dental care delivered to members and the service extended to dental providers.

In 1999, the Department hosted the very first Dental Summit. MCOs, advocates, dental care providers and other stakeholders attended the Dental Summit. The purpose of the Summit was to discuss ways to improve the dental care accessed by MA recipients. At the Summit, attendees expressed significant concerns about the low reimbursement rates provided to dental providers and the adverse effects reimbursement rates were having on dental provider enrollment. In response to this concern, resources were devoted to researching the fees paid by the MA program relative to fees paid in the commercial markets and other public programs. As a result of these efforts, fees were increased for numerous services. Affected fees were increased as much as 76 percent. For a complete listing of the fee increases implemented since 1999, refer to MA Bulletin 03-01-03, MA Bulletin 03-99-01 and MA Bulletin 03-01-06.

In response to Pennsylvania’s specific challenges, five objectives were identified during the 1999 Dental Summit:

To simplify program administration.
To build provider capacity in the managed care and fee-for-service delivery system.
To educate and outreach to all stakeholders.
To increase reimbursement.
To improve quality of oral health services.

Since the identification of these five main objectives in 1999, the Department has steadily worked to improve the quality of and access to dental care provided by the MA program. In the past three years the Department has:

Streamlined the provider enrollment process;
Implemented creative initiatives to attract dentists to areas with limited capacity to provide dental services;
Educated MA recipients about the need for regular dental care;
Increased dental fees as much as 76 percent; and
Expanded the Medical Assistance Transportation Program (MATP) to provide transportation to dental appointments in each county to address concerns from dental providers that recipients often do not show up to appointments because of lack of transportation.

DPW is pleased to report the progress made thus far and looks forward to continuing to work with advocates, policymakers and stakeholders to continue improving the quality of care and accessibility of dental services provided to MA recipients.

In November 2001, the Department held the second Dental Summit in Harrisburg. The theme of the summit was "Meeting the Challenge At All Levels." Providers, recipients and stakeholders from around the Commonwealth joined the Department staff to discuss how to improve access to and quality of dental services in local communities. The Secretary of the Department of Public Welfare delivered the Summit’s opening address. Summit participants spent much of the conference meeting in zone-specific workgroups. Each workgroup developed strategies to improve access to dental services for MA recipients in their zone.

The Dental Summit Steering Committee is responsible for prioritizing, developing and implementing recommendations for improving the dental services provided to MA recipients on an ongoing basis. The Dental Summit Steering Committee is composed of 17 members that represent the Department of Public Welfare, Department of Health, Pennsylvania Dental Association, dental providers, recipients, advocates and managed care organizations.

Robert Wood Johnson Foundation Oral Health Grant:

Pennsylvania received a three-year grant of $939,590 in December 2002 from the Robert Wood Johnson Foundation to improve oral health. Pennsylvania and five other states will work with the Centers for Health Care Strategies, Inc. to produce "comprehensive, innovative approaches to improve access to oral health services for low-income, minority and disabled populations served by Medicaid and the State Children's Health Insurance Program (SCHIP)". Pennsylvania will use the grant money to develop a program that has the following three components:

Training: The Commonwealth will work with the Pennsylvania Dental Society, dental training institutions, the Pennsylvania Forum for Primary HealthCare and safety net clinics to increase the number of Expanded Function Dental Assistants which will expand the provider network and target Dental Safety Net clinics.
Expanding the Dental Safety Net for Medicaid Special Needs Recipients: The Commonwealth will develop clinics that model Philadelphia's "Special Smiles" Clinic, which provides comprehensive treatment to special needs patients. This will be a joint effort between the Department of Public Welfare and the State's Medicaid managed care organizations.
Dental Recruitment and Referral: The Commonwealth will assess the willingness of dentists to treat Medical Assistance and CHIP special needs recipients as part of the Special Kids network. The Commonwealth will work with advocacy groups to distribute information about the referral networks via toll-free telephone numbers.

Other State And Local Efforts:

Great strides are being made in Pennsylvania to improve MA recipients’ access to quality dental care. All across the Commonwealth, initiatives are being implemented through state and local partnerships. Provided below is a summary of some of those initiatives:

Water Fluoridation Grant Program – The Pennsylvania Department of Health and the Pennsylvania Dental Association offered $300,000 in grants to localities with fluoride-deficient water systems to assist them in converting to fluoridated water systems. Fluoride has been proven as a safe and effective method in preventing tooth decay.
Community Primary Care Challenge Grants - The Department of Health has awarded over $1 million to eight organizations with plans to develop and implement medical and dental clinics in underserved areas and to add staff to existing clinics. The following counties received grant money: Alleghany, Columbia, Delaware, Franklin, Fulton, Lycoming, McKean and Northumberland.
Loan Repayment Program - The Department of Health offers loan repayment funds to practitioners, including dentists, in exchange for a commitment to provide services in underserved areas for a designated amount of time.

Medical Assistance Advisory Committee Updates:

The Medical Assistance Advisory Committee (MAAC) provides the Department with advice on how to improve access to quality health care in an efficient, economical and responsible manner to all MA eligibles. The MAAC is composed of 25 members representing consumers, advocacy organizations, providers and their associates, managed care organizations, medical centers and the Department. The MAAC meets once a month to discuss policy development and program administration issues, including dental care. For complete information on recent MAAC decisions and upcoming meetings, refer to the MAAC section of this website.

Helpful Links For Advocates:

Pennsylvania Department Of Health - Provides information regarding statewide and local dental initiatives, available grants and more.
American Dental Association - Provides information on legislative and regulatory issues, federal dental services, advocacy tips and more.
Pennsylvania Dental Association - Provides information on patient relations programs, consumer tips, current trends in dental care and more.
Eastern Dental Society - Provides information and continuing education opportunities to dental practitioners.

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