The NCSL Blog


By Erik Skinner

Children in Medicaid received more than 7 million fewer dental services between March and May of this year compared to the same period last year.

Child in dentist's chairThe problem is not confined to Medicaid, as the COVID-19 pandemic also exacerbated broader disparities in children accessing preventive oral health services. The pandemic suspended school-based health center programs, which can be the only source of dental care for low-income and minority children who also experience disparities such as lower rates of dental utilization and lower rates of dental insurance.

School-based health centers, federally qualified health centers, the Children’s Health Insurance Program and Medicaid programs, and academic institutions are community settings that make up the oral health safety net.

This safety net serves one-third of the U.S. population, primarily minority, low-income and underserved groups, making it a central mechanism to address oral health disparities. While the pandemic has limited these community-based options for delivering children’s oral health services, state public health strategies can provide options for policymakers to close gaps in care.

This year saw less state legislation related to children’s oral health compared to previous years. However, four states passed bills to address the oral health workforce in community settings for children.

  • In Nebraska, the legislature expanded dental hygienists’ authority to provide services to children and other populations in public health settings, such as schools and community health centers.
  • Iowa passed a bill to certify dental assistants to administer dental sealants subject to rules from the Board of Dentistry.
  • Virginia passed a bill allowing medical assistants to apply fluoride varnish after receiving a verbal order, written order or standing protocol from a doctor of medicine, osteopathic medicine or dentistry.
  • The Ohio General Assembly passed a law to allow for mobile dental clinics to provide services to children with permission from their parents.

For dental clinics in rural areas, school-based health centers and other community settings, teledentistry can be a tool to reach vulnerable children. While not always specific to children, providers can use teledentistry to maintain routine care and identify children with more urgent oral health issues.

Teledentistry has expanded rapidly since the beginning of the pandemic, and at least 15 states addressed their policies since then. For example, Oregon issued guidance in September on changes to billing and service processes for teledentistry. Utah passed legislation in March to provide for teledentistry services by dental professionals in the state.

Pre-pandemic state action on teledentistry also affects current practices and services. Illinois enacted legislation in May 2019 to define teledentistry and authorize asynchronous and synchronous communications for patient care and education. Ohio passed legislation in March 2019 to define teledentistry, authorize its use and require coverage to the same extent as services provided in person.

States also address teledentistry through the department of health and the Medicaid rulemaking process.

  • In Rhode Island, the department of health used funds from a Health Resources and Services Administration (HRSA) grant to implement virtual dental homes in high-need schools.
  • Texas’s Smiles in Schools program transitioned to providing virtual oral health education and toolkits in place of in-person screening activities.
  • Arizona developed a Medicaid billing manual that defines teledentistry and its authorized activities.

Delivering dental care to children, virtually when necessary, is currently a moving target for many policymakers and providers. As the coronavirus persists, states continue to pursue policies and strategies – leveraging workforce, teledentistry and other policy tools – to meet families where they are and reach children in a variety of settings to mitigate the effects of the pandemic.

NCSL Resources

NCSL would like to acknowledge the DentaQuest Partnership for Oral Health Advancement for supporting this blog post.

Erik Skinner is a policy associate in NCSL’s health program.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.