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Why Oral Health Care is Important for Children with Special Needs
& How to Access It in Illinois Affordable Care Act (ACA) Tip Sheet - June 2014
The Affordable Care Act (ACA) makes it possible for more children to have access to dental care. Parents of children with special needs may have so many doctors’ appointments that it can be easy to forget about preventive and wellness care. It can be especially difficult to focus on dental care. However, oral health is as important as physical health and, if untreated, oral health problems can result in serious complications.
Importance of Good Dental Care Did you know that, by age eleven, 50% of children have tooth decay? Untreated cavities allow bacteria to enter the bloodstream. In 2007, there was a tragic case of a 12-year-old boy who died from an untreated toothache. http://abcnews.go.com/Health/Dental/story?id=2925584&page=1.
Children with special health care needs may have more difficulty obtaining good dental care than other children, since:
(1) Health condition may affect motor skills involved in everyday dental care,
(2) Medications may affect their teeth, and/or
(3) Behaviors may make visits to the dentist more challenging.
Finding Dental Coverage
The Affordable Care Act (ACA) includes dental coverage for children as an “essential health benefit.” In some plans, dental care is included with overall medical coverage, and there are also “stand-alone” plans. Parents can find out if dental coverage is in their plan at www.healthcare.gov/find-premium-estimates/.
Families can also find a separate dental plan at www.healthcare.gov/dental-plan-information/. The Children’s Dental Health Project and Families USA have developed a new guide, “Buying Children’s Dental Coverage Through the Marketplace,” which is available at www.statereforum.org/system/files/buying_childrens_dental_coverage_through_the_marketplace.pdf.
The American Academy of Pediatric Dentistry has a “find a pediatric dentist” search feature on their website: http://www.aapd.org/ Dental coverage for adults will also be available through the Marketplace at an additional cost.
If you live in Illinois and need insurance, visit the Marketplace at ww.GetCoveredIllinois.gov or call the toll-free Help Desk at (866) 311-1119, open seven days a week from 8 a.m. to 8 p.m.
All Kids/Medicaid also provides dental coverage as part of the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit, and a referral to a dentist is required for every child consistent with the periodicity table set by each state. See www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Dental-Care.html.
EverThrive Illinois has a new detailed fact sheet on All Kids/Medicaid dental coverage for children and adults, including benefits by age group, how to find a dentist, and resources for the uninsured: http://www.ilmaternal.org/docs/factsheets/DentalFactSheet6-30-14.pdf Dental benefits for adults age 21 and older insured by Illinois Medicaid were restored on July 1, 2014: http://hfs.illinois.gov/html/062714n.html
The Illinois Department of Healthcare and Family Services has a Dental Policy Review Committee, which meets in Chicago and Springfield. Meetings are open to the public. For more information, see: http://www2.illinois.gov/hfs/PublicInvolvement/BoardsandCommisions/default/Pages/schedule.aspx
Information on Illinois Medicaid Dental Providers is available at: http://www.hfs.illinois.gov/dentists/ There are also organizations that provide free or reduced-cost dental care. See www.nidcr.nih.gov/oralhealth/popularpublications/findinglowcostdentalcare/.
For the Uninsured Although some families may have missed the deadline to purchase private insurance through the health insurance exchange/marketplace for this year, eligible children may enroll in Medicaid or All Kids at any time, or a family may qualify for a special enrollment period. This can be checked at www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/#part=2. Even if families cannot get health insurance coverage, they still may be able to get help to pay for dental care.
Federally Qualified Health Centers (FQHCs) must provide dental care and can be found at http://findahealthcenter.hrsa.gov/Search_HCC.aspx.
There is also the National Association of Free & Charitable Clinics at www.nafcclinics.org. Donated Dental Services can help to identify dentists who provide free care, some even in schools or through house calls. Also through this program, states host free dental-care days each year. For eligibility requirements and to find a program, see http://dentallifeline.org/about-us/our-programs/#Bridge-Campaign-of-Concern.
In addition, Smile for a Lifetime offers free orthodontia. Information about this program is available at http://slf.memberclicks.net/zip-code-search.
Notices about free dental care programs around Illinois are posted on our Facebook page as we receive them: https://www.facebook.com/ilfamilyvoices?ref_type=bookmark
Families need to let their child’s dentist know about factors that influence oral health. This can include medications, restrictions, information on their child’s skills, and/or behavioral factors.
Families can also ask their dental providers what serious signs and symptoms to watch for, such as fever, headache, pain, or swelling that might indicate dental problems.
Pediatric dentists can recommend great tools for maintaining good oral care, such as electric toothbrushes which can help with motor skills ( some even play pop tunes), floss (dinosaur-shaped flossers for kids), or other aids, like plaque remover, fluoride rinse, mouthwash or special cleaning devices (irrigation machines).
Families should try to help their children maintain good oral health habits, which might mean remembering to bring special oral care supplies (such as orthodontic appliances) to the hospital when a child is admitted.
The American Academy of Pediatrics Healthy Kids website has information on oral health and diet at:
Children who have IEPs (Individualized Education Plans for special education services and supports) can have oral health goals incorporated into their school day. See our publication “Tools for School” for more information:
Parents may have to catch up on routine dental appointments when hospitalizations or other health crises have passed.
Families of children with disabilities want the best care for their children. This includes oral health - an important component of overall health!
Healthy Kids has more information on this topic on their website:
Please contact Family Voices of Illinois at 866-931-1110 or firstname.lastname@example.org
If you have any questions or need more information on oral health care.
Additional Resources Bright Futures in Practice: Oral Health—Pocket Guide
Dental Tool Kit – Autism Speaks
http://www.autismspeaks.org/family-services/tool-kits/dental-tool-kit Oral Health - American Academy of Pediatrics
Spanish: http://www.healthychildren.org/spanish/healthy-living/oral-health/paginas/default.aspx Oral Health - Maternal/Child Health Knowledge Path
http://www.mchoralhealth.org/ Oral Health Tips - Vanderbilt Kennedy Center
This tip sheet was authored by Lauren Agoratus, M.A. Lauren is the parent of a child with multiple disabilities who serves as the Coordinator for Family Voices - NJ and as the southern coordinator in her the New Jersey Family-to-Family Health Information Center, both housed at the Statewide Parent Advocacy Network (SPAN) at www.spanadvocacy.org .
More of Lauren’s tips about the ACA can be found on the website of the Family Voices National Center for Family/Professional Partnerships: http://www.fv-ncfpp.org/.
This publication was developed in partnership with Family Voices, Inc. * 3701 San Mateo Blvd. NE, Suite 103, Albuquerque, NM 87110 * 505-872-4774 * www.familyvoices.org. It has been adapted specifically for Illinois with permission of the author and Family Voices, Inc.
Special thanks to our project partners for reviewing this tip sheet and providing us with helpful feedback: