• Mission & Governance
• Services Overview
• How to Get Involved
• Standing Committees
• NCSL Foundation

• Issue Areas: A-Z
• State-Federal Relations
• NCSL Standing Committees
• News from D.C. and the States

• About State Legislatures
• Elections, Campaigns & Redistricting
• NCSL's StateConnect Directory
• Web Sites

• Online Guide to NCSL Services
• Staff Sections and Networks
• Meetings & Professional Development
• Staff Directories

• Meetings Calendar
• Online Registration
• Meetings Home Page
• Legislative Summit

• Bookstore
• State Legislatures Magazine
• NCSL's StateConnect Directory

ON THE HORIZON

In addition to improving oral health, states may realize significant cost savings in Medicaid by using community water fluoridation or school-based sealant programs to prevent tooth decay. It costs less than $1 per person annually to fluoridate public water systems, and the Centers for Disease Control (CDC) estimates that every $1 spent on community water fluoridation saves $7 to $42 in treatment costs, depending on the size of the community. Fluoridating community water systems could, therefore, have a major effect on state Medicaid budgets, especially considering that low-income people are disproportionately affected by poor oral health.

• In Louisiana, a CDC study of Medicaid-eligible preschool age children in fluoridated and non-fluoridated communities found that children in fluoridated parishes fared better than children in non-fluoridated parishes in overall oral health. The researchers looked at data on Medicaid dental reimbursements throughout the state and found that the cost of dental treatment per Medicaid eligible child was twice as high in non-fluoridated communities. The difference in per visit treatment costs for people in the fluoridated and unfluoridated communities ranged from $15 to $60, depending on age. With at least 39,000 Medicaid-eligible preschool age children not receiving fluoridated water in Louisiana, the CDC estimated that the state could save $1.4 million annually in dental treatment costs by fluoridating the remaining public water systems. That amounts to about $35 annually per child at a cost of less than $1 per capita.

School-based sealant programs may also have a positive effect on oral health without increasing state Medicaid spending. Less than one-quarter of children in the United States have dental sealants. The CDC estimates that increasing the percentage of high-risk children in school sealant programs to 50 percent could reduce the rate of tooth decay in these children by half. The Medicaid reimbursement rate for a dental sealant typically is lower than the cost of treating tooth decay, and studies have suggested that targeting dental sealant programs to high-risk children through school-based programs has the potential to save states almost $12 per tooth in treatment spending.

• In North Carolina, the Agency for Healthcare Research and Quality conducted a study on the costs of dental sealants for children enrolled in Medicaid. Looking at 15,438 children in the Medicaid program from 1985 to 1992, the researchers concluded that the use of dental sealants produced Medicaid savings for children who were prone to cavities. In the study, the Medicaid reimbursement for dental sealants was $11 compared to $18 for the cost of treating a decayed tooth. The study found that Medicaid could save up to $15 per tooth for children at high risk by using dental sealants.

Preventing tooth decay through comparatively inexpensive initiatives such as water fluoridation and school-based sealant programs has the potential not only to improve oral health but also to help state Medicaid budgets. It should be noted that opponents of water fluoridation suggest that states may not see cost savings if it raises costs associated with treating dental fluorosis. To date, not enough studies have been conducted on the potential costs of treating fluorosis to determine how much of an impact increased fluorosis would have on expenditures. Nonetheless states may want to carefully examine the different ways to also prevent tooth decay as ways to produce cost savings.

TO NEXT SECTION (DIGGING DEEPER)

BACK TO MAIN