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Highlights

The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) required GAO to study children's access to dental care. GAO assessed (1) the extent to which dentists participate in Medicaid and the Children's Health Insurance Program (CHIP) and federal efforts to help families find participating dentists; (2) data on access for Medicaid and CHIP children in different states and in managed care; (3) federal efforts to improve access in underserved areas; and (4) how states and other countries have used mid-level dental providers to improve children's access. To do this, GAO (1) examined state reported dentist participation and the Department of Health and Human Services's (HHS) Insure Kids Now Web site for all 50 states and the District of Columbia and called a non-representative sample of dentists in four states; (2) reviewed national data on provision of Medicaid dental services and use of managed care; (3) interviewed HHS officials and assessed certain HHS dental programs; and (4) interviewed officials in eight states and four countries on the use of mid-level and other dental providers.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services 1. To enhance the provision of dental care to children covered by Medicaid and CHIP, and to help ensure that HHS's Insure Kids Now Web site is a useful tool to help connect children covered by Medicaid and CHIP with participating dentists who will treat them, the Secretary of HHS should establish a process to periodically verify that the dentist lists posted by states on the Insure Kids Now Web site are complete, usable, and accurate, and ensure that states and participating dentists have a common understanding of what it means for a dentist to indicate he or she can treat children with special needs.
Closed - Implemented
HHS has reported taking steps to improve the data on the Insure Kids Now website, including establishing an ongoing system to check that data are in the correct format and conducting validation surveys. The Centers for Medicare & Medicaid Services (CMS) has also provided training to Medicaid staff on identifying dentists' capabilities to treat children with special needs and has developed and disseminated a flyer for families on how to identify dentists who can treat children with special needs and questions to ask to ensure that dentists understand their needs.
Department of Health and Human Services 2. To enhance the provision of dental care to children covered by Medicaid and CHIP, and to help ensure that HHS's Insure Kids Now Web site is a useful tool to help connect children covered by Medicaid and CHIP with participating dentists who will treat them, the Secretary of HHS should provide alternate sources of information, such as HHS's toll-free 1-877-KIDS-NOW telephone number, on the Insure Kids Now Web site when a page or link from the Web site is not functioning or taken offline for maintenance.
Closed - Implemented
The Insure Kids Now website now has the 1-877-KIDS-NOW phone number listed on the home page and every state specific web page, as a backup for when links from the website are not functional.
Department of Health and Human Services 3. To enhance the provision of dental care to children covered by Medicaid and CHIP, and to help ensure that HHS's Insure Kids Now Web site is a useful tool to help connect children covered by Medicaid and CHIP with participating dentists who will treat them, the Secretary of HHS should require states to verify that dentists listed on the Insure Kids Now Web site have not been excluded from Medicaid and CHIP by the HHS-OIG, and periodically verify that excluded providers are not included on the lists posted by the states.
Open
As of September 2020, CMS has not indicated taking steps to require states to ensure excluded providers are not listed on the Insure Kids Now website, nor has it indicated taking steps to periodically verify that providers excluded from Medicaid and CHIP are not on the list. CMS has said that it relies on states to provide accurate lists of eligible dentists and that data issues prevent the agency from independently verifying that excluded providers are not included on the Insure Kids Now website. We continue to believe that CMS should require states to ensure that excluded providers are not listed on the website and periodically verify that excluded providers are not included on the lists posted by the states, so that the website does not present inaccurate information about providers available to serve Medicaid-covered children.
Centers for Medicare and Medicaid Services 4. To enhance the provision of dental care to children covered by Medicaid and CHIP, and to strengthen CMS oversight of Medicaid and CHIP dental services provided by dental managed care programs, the Administrator of the Centers for Medicare & Medicaid Services (CMS) should take steps to ensure that states gather comprehensive and reliable data on the provision of Medicaid and CHIP dental services by managed care programs.
Closed - Implemented
CMS has revised the instructions for its Form-416, beginning in FY 2014, to specify that fields collecting data on dental service utilization be inclusive of Medicaid beneficiaries enrolled in managed care.

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