Public Dental Programs

How is public financing for dental care categorical in nature?

it is based on age, income, and health status

Who is least likely to have private or public dental insurance (medicaid)

people aged 65+

Medicare is _______ funded and is for people 65+ where was medicaid coverage is for the ______ population

federally ; indigent

In publicly financed programs, who is the third party?

the government

What are the levels of public programs? (3)

1. local/state level:

- community/public health centers

- dental schools

2. national level:

- armed services

- veterans administration

3. international level:

- world health organization

What does the Center for Disease Control (CDC) do for public health?

- chronic disease prevention & health promotion

- national center for infectious diseases & health statistics

- develops policies

- develops OSHA guidelines

- research & data

What does the Food and Drug Administration (FDA) do for public health?

- safety & effectiveness of products

- regulates equipment, materials, products, medications etc

What does the National Institute of Health (NIH) do for public health?

- it is a MAJOR research hub with 27 different departments

What is the historical perspective for US PH programs? What programs does it include?

merchant marines experienced diseases → govt wanted to stop the spread so it established federal funding medical care for seamen → US PHs provided work for officers, civil servants, or independent contractors

includes: indian health services, federal bureau of prisons, and US coast guard

What is the purpose of the social security act? When was it developed?

- to provide income for the elderly

- payments went to recipient

+developed during the great depression in 1935*

What is the purpose of the Kerr Mills bill? When was it developed?

- first bill to make vender payments and have insurance as a 3rd party.

- the poor and elderly +65 could have their healthcare needs taken care of but it failed

- developed in 1960

What titles were added to the social security act as amendments in 1967?

Title 18 - Medicare

Title 19 - Medicaid

What title was added to the social security act as an amendment in 1997?

Title 21 - State Children's Health Insurance Program (S-CHIP)

(T/F): Medicare is fully federally funded

true

Who is medicare for?

- Those 65+ years old

- certain medically disabled persons regardless of age

Describe part A of medicare

automatic enrollment at age 65

- hospital care, some health care, some nursing home care and hospice services

- no annual premium if enough work credits

- annual deductibles

Describe part B of medicare

optional enrollment

- physician's services, outpatient care, preventive services

- monthly premium deducted from social security check

- annual deductible

Describe part D of medicare

optional enrollment

- prescription coverage

- many choices available

What dental care is covered by medicare?

- jaw fractures

- preparation of oral and pharyngeal cancer patient for radiation (extractions)

- oral exam prior to renal transplant surgery or heart valve replacement (only in certain circumstances though)

NO coverage for routine density or dentures

(T/F): medicaid is fully federally funded

F; its jointly funded by state/federally

*amount paid by federal

government based on per capita income of state*

How do eligibility standards work for medicaid?

standards vary state by state:

- based on family income level (below 100% federal poverty level) and age

- minimum standards set by feds ; states can extend beyond minimum standards

poorer the state, the more fed funding

What basic services does the state have to cover to get federally medicaid funding?

- inpatient and outpatient hospital services

- physician services

- laboratory and xray

- nursing home and home health

- early and periodic screening, diagnosis, and treatment (EPSDT) for 21 and under

- family planning

states decide what else to cover

(T/F): the majority of medicaid beneficiaries are low income families

F; they are only a small percentage, the majority is designated for acute care and long term care for disabled and elderly

Nationally, ___ in 5 children are covered under medicaid

1

(T/F): less than half the states providing medicaid provide comprehensive care

true

What are the dental barriers of medicaid? (6)

1. provider participation:

- limited provider participation makes finding a dentist hard

2. reimbursement rates:

- can be as low as about 30 to 50% in some states

3. Broken appointments

4. Geographical barriers

5. Personal behaviors

6. Red tape

What areas are often without dentists?

rural and low income areas

How does personal behavior lead to dental medicaid barriers

poor compliance; lack of value based on preventive care

How does red tape lead to dental medicaid barriers?

problems and complexity of processing paperwork for reimbursement ; not easy for providers to enroll

What is the purpose of S-CHIP?

to broaden income eligibility guidelines for health insurance coverage for children

- can expand Medicaid to cover more children or create new insurance program

- Target's children to age 19 up to 200% of federal poverty line ("working poor")

how does S-CHIP differ from Medicaid?

- can include copayments, monthly premiums and annual payment limits

- outreach efforts to enroll eligible people

- simplified enrollment procedures

some concerns are limited funding and limited provider participation

what is the purpose of the Headstart program?

Federal program started in 1965 to provide health and social services to underprivileged preschool children to better prepare them for school

targets low-income children ages 3 to 5