Reimbursing Physicians for Fluoride Varnish
This information is up-to-date as of June 2015. TennCare, Tennessee’s Medicaid managed care program, will now compensate pediatric health professionals for tooth decay prevention services in accordance with the United States Preventive Services Task Force recommendations.
A Cost-effective Solution to Improving Access
Young children see primary medical care providers earlier and more frequently than they see dentists. This is particularly true for children in low-income families, who face persistent barriers to accessing dental care.
For these reasons, the medical office is an ideal place to deliver a set of preventive dental services—including the application of fluoride varnish.
By compensating physicians through Medicaid for providing valuable dental care intervention, states can help reduce the tremendous access barriers low-income children face when trying to obtain much needed oral health care services. Pew and the American Academy of Pediatrics encourage all states to adopt this reimbursement policy.
Why is Fluoride Varnish Cost Effective?
Twenty-eight percent of children aged two to five have had cavities and, of these children, 73 percent were in need of treatment. Fluoride varnish offers the following benefits:
- Fluoride varnish applied at primary medical care visits can reduce decay rates by one-third, and lead to significant cost savings in restorative dental care and associated hospital costs.
- The lack of access to preventive dental measures can result in high costs for complex restorative procedures, especially if the child requires hospital-based care. Such care can cost as much as $15,000 per admission, carries a slight but real risk of anesthetic death, and places big burdens on public resources and state Medicaid budgets.
- Fluoride varnish is an inexpensive preventive measure that can curb high costs to state Medicaid programs for treating tooth decay. Most Medicaid programs pay between $15 and $30 for the procedure, and some also separately reimburse for screening, anticipatory guidance, and risk assessment.
Currently, 46 states and the District of Columbia have Medicaid programs that pay medical providers for preventive dental care. In North Carolina, a leader in the field, these services reached 60,000 children under age 4 in 2007.
For more information, see the 2009 issue brief from the National Academy for State Health Policy (NASHP) as well as presentations from Pew’s September 2009 webcast on the importance of engaging medical providers in caring for young children’s oral health needs. Information is also available from your state chapter of the American Academy of Pediatrics