Future direction for reform

Medicaid is the nation's major public health coverage program for low-income Americans. In 2005, expenditures for dental services under the Medicaid and SCHIP programs totaled about $4.8 billion, representing about 93% of all public expenditures for dental services in the US. Few states, however, include coverage for dental services for adults, states vary widely in their implementation of SCHIP for children's dental services, and utilization of children's services varies considerably within and between states. Access under the Medicaid program is not universal, the focus of dental care is often directed toward treatment rather than prevention, and oral health disparities persist. In addition, available data may be insufficient for appropriate oversight of children's dental services. This presentation will promote the adoption of a systems perspective to improve oral health care services for Medicaid beneficiaries and will describe overarching goals for system transformation. We will also discuss various ways to create change within Medicaid programs, including, for example, stimulating innovation, building a knowledge base, building capacity and workforce, strengthening infrastructure within the dental safety net, and enhancing the impact of advocacy and policy analysis.