US Congress and dental access: Overview and direction

Since the enactment of SCHIP 10 years ago, the US Congress and Federal regulators at the Centers for Medicare and Medicaid Services have steadily moved publicly financed health coverage in new directions. These directions reflect both (1) increased state autonomy and flexibility and (2) increased emulation of commercial insurance standards. While these directions closely emulate secular medical - rather than dental - coverage trends, they have a profound impact on the delivery of dental services to low income populations. We examine how this progression of recent legislation and regulation modify assumptions first codified in the 1967 Medicaid Early and Periodic Screening Diagnosis and Treatment (EPSDT)program. Specifically, we consider how (1) the original enactment of State Child Health Insurance Program (SCHIP), (2) the Health Insurance Flexibility and Accountability waiver program (HIFA), (3) the Deficit Reduction Act (DRA), and (4) the reauthorization of SCHIP together constitute a continuum of policy change that reflects increasing federalism and commercialism. We consider how these initiatives create potential for both negative impact on services and new opportunities for experimentation as the role of government-sponsored dental coverage for vulnerable children continues to evolve.