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128-482: While a small number of cases and anecdotes regarding high EPSDT costs have garnered public attention, spending per child is low compared with worker-age adults and seniors covered by Medicaid. This is true despite the breadth of coverage provided to children through EPSDT. Children account for approximately half of Medicaid beneficiaries but only roughly 20-25 percent of the costs of the program overall. With Medicaid and EPSDT, however, poor children's access to health care

256-670: A Tang dynasty medical text written by the Chinese physician Su Kung in 659, and appeared in Germany in 1528. During the Islamic Golden Age Dentistry was discussed in several famous books of medicine such as The Canon in medicine written by Avicenna and Al-Tasreef by Al-Zahrawi who is considered the greatest surgeon of the Middle Ages , Avicenna said that jaw fracture should be reduced according to

384-544: A "free appropriate public education" under Section 504 of The Rehabilitation Act of 1973. Decisions by the United States Supreme Court and subsequent changes in federal law require states to reimburse part or all of the cost of some services provided by schools for Medicaid-eligible disabled children. The Affordable Care Act (ACA), passed in 2010, substantially expanded the Medicaid program. Before

512-536: A bid to incorporate the school. Studies show that dentists that graduated from different countries, or even from different dental schools in one country, may make different clinical decisions for the same clinical condition. For example, dentists that graduated from Israeli dental schools may recommend the removal of asymptomatic impacted third molar (wisdom teeth) more often than dentists that graduated from Latin American or Eastern European dental schools. In

640-649: A broad array of prevention and treatment services. In turn, states have responsibility for certain policy implementation decisions. For example, states determine provider qualifications, set payment levels, create benefit definitions, and make medical necessity determinations. As state Medicaid agencies adopt managed care approaches, Medicaid has evolved. Early studies of Medicaid managed care indicated that children may have received fewer visits or services. More recent studies point to states use of quality improvement projects, improved contracts, and other mechanisms which can optimize care. How states implement and manage EPSDT

768-420: A dentist as part of a comprehensive EPSDT screening visit. If a condition requiring treatment is discovered for a child, EPSDT provides financing for nearly all medically necessary dental services. Vision services, at a minimum, include diagnosis and treatment for defects in vision and eyeglasses when appropriate. Vision services must be provided according to a distinct, separate periodicity schedule developed by

896-667: A few countries, to become a qualified dentist one must usually complete at least four years of postgraduate study; Dental degrees awarded around the world include the Doctor of Dental Surgery (DDS) and Doctor of Dental Medicine (DMD) in North America (US and Canada), and the Bachelor of Dental Surgery/Baccalaureus Dentalis Chirurgiae (BDS, BDent, BChD, BDSc) in the UK and current and former British Commonwealth countries. All dentists in

1024-630: A managed care plan or medical home. First, every state should adopt a periodic visit (periodicity) schedule that conforms to the model of the American Academy of Pediatrics. The visit content should conform to the Bright Futures guidelines. These professional guidelines are based on the best available evidence regarding what works for children in pediatric care and what can be achieved through well-child visits. Second, states should clearly communicate to families and providers regarding

1152-1030: A number of activities. Currently, the Title V law requires that state MCH programs to: assist with coordination of EPSDT, establish coordination agreements for with their State Medicaid programs, provide a toll-free number for families seeking Title V or Medicaid providers, provide outreach and facilitate enrollment of Medicaid eligible children and pregnant women, share data collection responsibilities, and provide services for children with special health care needs and disabilities not covered by Medicaid. Reciprocally, federal EPSDT rules call for coordination with Title V. These requirements call for Medicaid agencies to: 1. establishment of written agreements which provide for maximum utilization of Title V-supported services and aims to improve child health status; and 2. reimbursement of Title V providers for services rendered, even if such services are provided free of charge to low-income uninsured families. The Children’s Health Insurance Program

1280-505: A program called Access to Baby and Child Dentistry (ABCD) has helped increase access to dental services by providing dentists higher reimbursements for oral health education and preventive and restorative services for children. After the passing of the Affordable Care Act , many dental practices began using dental service organizations to provide business management and support, allowing practices to minimize costs and pass

1408-565: A remarkable achievement for the period. Major advances in science were made in the 19th century, and dentistry evolved from a trade to a profession. The profession came under government regulation by the end of the 19th century. In the UK, the Dentist Act was passed in 1878 and the British Dental Association formed in 1879. In the same year, Francis Brodie Imlach was the first ever dentist to be elected President of

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1536-434: A remedy. Expanding health coverage for low-income since the mid-1980s has made a significant contribution to their appropriate use of health services and to their health status. While EPSDT is a primary reason for improvements in the health, barriers to care beyond coverage inhibit the potential of this benefit. A number of studies have documented low performance of EPSDT programs in some states or communities. This includes

1664-502: A set of benefits, offers a comprehensive approach to medical, dental, and mental health care for children which emphasizes prevention and early intervention. The core of the EPSDT benefit is a comprehensive, well-child visit known as an EPSDT screen. It must include: a comprehensive health and developmental history, comprehensive physical exam, appropriate immunizations, laboratory tests, and health education. The general design and content of

1792-477: A significant portion of their funding. Medicaid was established in 1965, part of the Great Society set of programs during President Lyndon Johnson’s Administration , and was significantly expanded by the Affordable Care Act (ACA), which was passed in 2010. In most states, any member of a household with income up to 138% of the federal poverty line qualifies for Medicaid coverage under the provisions of

1920-588: A significant proportion of Medicaid enrollees. As of 2014, 26 states have contracts with managed care organizations (MCOs) to deliver long-term care for the elderly and individuals with disabilities. The states pay a monthly capitated rate per member to the MCOs, which in turn provide comprehensive care and accept the risk of managing total costs. Nationwide, roughly 80% of Medicaid enrollees are enrolled in managed care plans. Core eligibility groups of low-income families are most likely to be enrolled in managed care, while

2048-505: Is a mandatory Medicaid program for children that focuses on prevention, early diagnosis and treatment of medical conditions. Oral screenings are not required for EPSDT recipients, and they do not suffice as a direct dental referral. If a condition requiring treatment is discovered during an oral screening, the state is responsible for paying for this service, regardless of whether or not it is covered on that particular Medicaid plan. Children enrolled in Medicaid are individually entitled under

2176-461: Is a movement in modern dentistry to place a greater emphasis on high-quality scientific evidence in decision-making. Evidence-based dentistry (EBD) uses current scientific evidence to guide decisions. It is an approach to oral health that requires the application and examination of relevant scientific data related to the patient's oral and medical health. Along with the dentist's professional skill and expertise, EBD allows dentists to stay up to date on

2304-403: Is a program that is not solely funded at the federal level. States provide up to half of the funding for Medicaid. In some states, counties also contribute funds. Unlike Medicare, Medicaid is a means-tested , needs-based social welfare or social protection program rather than a social insurance program. Eligibility is determined largely by income. The main criterion for Medicaid eligibility

2432-401: Is a universal program providing health coverage for the elderly. Medicaid offers elder care benefits not normally covered by Medicare, including nursing home care and personal care services. There are also dual health plans for people who have both Medicaid and Medicare. Along with Medicare, Tricare , and ChampVA , Medicaid is one of the four government-sponsored medical insurance programs in

2560-409: Is administered as part of the Medicaid program (referred to as Medicaid expansion states) and the covered children are eligible for EPSDT benefits. In other states, CHIP may be administered by the state and designed similar to Medicaid but not provide full EPSDT coverage, or CHIP may be administered as a private plan without the more comprehensive EPSDT benefits. Separate administration has proved to be

2688-498: Is considered to have stemmed from the trade of barber surgeons . Dental treatments are carried out by a dental team, which often consists of a dentist and dental auxiliaries (such as dental assistants , dental hygienists , dental technicians , and dental therapists ). Most dentists either work in private practices ( primary care ), dental hospitals, or ( secondary care ) institutions (prisons, armed forces bases, etc.). The modern movement of evidence-based dentistry calls for

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2816-528: Is defined vary from state to state. As of 2019, when Medicaid has been expanded under the PPACA, eligibility is determined by an income test using Modified Adjusted Gross Income , with no state-specific variations and a prohibition on asset or resource tests. While Medicaid expansion available to adults under the PPACA mandates a standard income-based test without asset or resource tests, other eligibility criteria such as assets may apply when eligible outside of

2944-715: Is exposed to sound levels above 90 dBA according to the Occupational Safety and Health Administration (OSHA). Regulations state that the permissible noise exposure levels for individuals is 90 dBA. For the National Institute for Occupational Safety and Health ( NIOSH ), exposure limits are set to 85 dBA. Exposures below 85 dBA are not considered to be hazardous. Time limits are placed on how long an individual can stay in an environment above 85 dBA before it causes hearing loss. OSHA places that limitation at 8 hours for 85 dBA. The exposure time becomes shorter as

3072-444: Is important to millions of children, particularly the youngest and most vulnerable. To conform with the prevention and early intervention goals of the program, states need to ensure coverage of development screening, optimize the frequency of covered visits, and offer incentives to provide comprehensive, age-appropriate care. Where states have failed to implement EPSDT law, families have sometimes brought lawsuits in an effort to secure

3200-413: Is largely consistent by state, and requirements on how to qualify or what benefits are provided are standard. However AFDC has differing eligibility standards that depend on: Beyond the variance in eligibility and coverage between states, there is a large variance in the reimbursements Medicaid offers to care providers; the clearest examples of this are common orthopedic procedures . For instance, in 2013,

3328-626: Is limited income and financial resources, a criterion which plays no role in determining Medicare coverage. Medicaid covers a wider range of health care services than Medicare. Some people are eligible for both Medicaid and Medicare and are known as Medicare dual eligible or medi-medi's. In 2001, about 6.5 million people were enrolled in both Medicare and Medicaid. In 2013, approximately 9 million people qualified for Medicare and Medicaid. There are two general types of Medicaid coverage. "Community Medicaid" helps people who have little or no medical insurance. Medicaid nursing home coverage helps pay for

3456-409: Is often also understood to subsume the now largely defunct medical specialty of stomatology (the study of the mouth and its disorders and diseases) for which reason the two terms are used interchangeably in certain regions. However, some specialties such as oral and maxillofacial surgery (facial reconstruction) may require both medical and dental degrees to accomplish. In European history, dentistry

3584-601: Is part of the larger movement toward evidence-based medicine and other evidence-based practices , especially since a major part of dentistry involves dealing with oral and systemic diseases. Other issues relevant to the dental field in terms of evidence-based research and evidence-based practice include population oral health, dental clinical practice, tooth morphology etc. Dentistry is unique in that it requires dental students to have competence-based clinical skills that can only be acquired through supervised specialized laboratory training and direct patient care. This necessitates

3712-867: Is referred to as "oral-systemic health". John M. Harris started the world's first dental school in Bainbridge, Ohio , and helped to establish dentistry as a health profession. It opened on 21 February 1828, and today is a dental museum . The first dental college, Baltimore College of Dental Surgery , opened in Baltimore, Maryland, US in 1840. The second in the United States was the Ohio College of Dental Surgery , established in Cincinnati, Ohio, in 1845. The Philadelphia College of Dental Surgery followed in 1852. In 1907, Temple University accepted

3840-413: Is set by a federal standard and goes beyond what states may cover for adults in Medicaid. Specifically, states are required by federal law to provide any additional health care services that are covered under the federal Medicaid program and found to be medically necessary regardless of whether the service is covered in a state’s Medicaid plan. Some common EPSDT treatment and intervention services beyond what

3968-532: Is similar to that of non-poor, privately insured children and child Medicaid beneficiaries use care in approximately the same pattern as their privately insured counterparts. On average, Medicaid costs per child are less than private insurance. EPSDT was enacted in 1967 as part of Medicaid as the child health component of Medicaid, with a deliberate focus on prevention and early intervention to reduce health problems among poor children and offer them equal opportunity to succeed in life. The design of EPSDT encompasses

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4096-482: Is typically covered for adults include: eyeglasses, hearing aids, orthodontia, wheelchairs and prosthetic devices, occupational and physical therapy, prescribed medical formula foods, assistive communication devices, personal care, therapeutic behavioral services, and substance abuse treatment Medicaid, as well as private insurers, will not pay for treatment for a covered individual unless they consider it to be medically necessary. In most private health plans, this means

4224-531: Is worse than that of people with higher income. The Census Bureau reported in September 2019 that states that expanded Medicaid under ACA had considerably lower uninsured rates than states that did not. For example, for adults between 100% and 399% of poverty level, the uninsured rate in 2018 was 12.7% in expansion states and 21.2% in non-expansion states. Of the 14 states with uninsured rates of 10% or greater, 11 had not expanded Medicaid. A July 2019 study by

4352-410: The 2008–2009 recession resulted in a substantial increase in Medicaid enrollment in 2009. Nine U.S. states showed an increase in enrollment of 15% or more, putting a heavy strain on state budgets. The Kaiser Family Foundation reported that for 2013, Medicaid recipients were 40% white, 21% black, 25% Hispanic, and 14% other races. Unlike Medicaid, Medicare is a social insurance program funded at

4480-536: The Supplemental Security Income (SSI) program for the aged, blind and disabled. States are required under federal law to provide all AFDC and SSI recipients with Medicaid coverage. Because eligibility for AFDC and SSI essentially guarantees Medicaid coverage, examining eligibility/coverage differences per state in AFDC and SSI is an accurate way to assess Medicaid differences as well. SSI coverage

4608-481: The data reporting . Title V of the Social Security Act was enacted in 1935 as a health services safety net for all women and children. It was the first programs to provide grants to states to improve health. Today, the Title V Maternal and Child Health Services Block Grant continues as the only federal program with the goal of improving the health of all mothers and children. Title V is administered by

4736-495: The oral mucosa . Dentistry may also encompass other aspects of the craniofacial complex including the temporomandibular joint . The practitioner is called a dentist . The history of dentistry is almost as ancient as the history of humanity and civilization, with the earliest evidence dating from 7000 BC to 5500 BC. Dentistry is thought to have been the first specialization in medicine which has gone on to develop its own accredited degree with its own specializations. Dentistry

4864-454: The "aged" and "disabled" eligibility groups more often remain in traditional " fee for service " Medicaid. Because service level costs vary depending on the care and needs of the enrolled, a cost per person average is only a rough measure of actual cost of care. The annual cost of care will vary state to state depending on state approved Medicaid benefits, as well as the state specific care costs. A 2014 Kaiser Family Foundation report estimates

4992-510: The 10% contribution in 2020. Some studies suggested that rejecting the expansion would cost more due to increased spending on uncompensated emergency care that otherwise would have been partially paid for by Medicaid coverage. A 2016 study found that residents of Kentucky and Arkansas , which both expanded Medicaid, were more likely to receive health care services and less likely to incur emergency room costs or have trouble paying their medical bills. Residents of Texas , which did not accept

5120-490: The 14th century, Guy de Chauliac most probably invented the dental pelican (resembling a pelican 's beak) which was used to perform dental extractions up until the late 18th century. The pelican was replaced by the dental key which, in turn, was replaced by modern forceps in the 19th century. The first book focused solely on dentistry was the "Artzney Buchlein" in 1530, and the first dental textbook written in English

5248-416: The 1980s, many states received waivers from the federal government to create Medicaid managed care programs. Under managed care, Medicaid recipients are enrolled in a private health plan, which receives a fixed monthly premium from the state. The health plan is then responsible for providing for all or most of the recipient's healthcare needs. Today, all but a few states use managed care to provide coverage to

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5376-522: The 5th century BC. The Phoenicians crafted dentures during the 6th–4th century BC, fashioning them from gold wire and incorporating two ivory teeth. In ancient Egypt, Hesy-Ra is the first named "dentist" (greatest of the teeth). The Egyptians bound replacement teeth together with gold wire. Roman medical writer Cornelius Celsus wrote extensively of oral diseases as well as dental treatments such as narcotic-containing emollients and astringents . The earliest dental amalgams were first documented in

5504-498: The ACA. A 2012 Supreme Court decision established that states may continue to use pre-ACA Medicaid eligibility standards and receive previously established levels of federal Medicaid funding; in states that make that choice, income limits may be significantly lower, and able-bodied adults may not be eligible for Medicaid at all. Medicaid is the largest source of funding for medical and health-related services for people with low income in

5632-474: The Affordable Care Act was a federally-funded increase in 2013 and 2014 in Medicaid payments to bring them up to 100% of equivalent Medicare payments, in an effort to increase provider participation. Most states did not subsequently continue this provision. In 2002, Medicaid enrollees numbered 39.9 million Americans, with the largest group being children (18.4 million or 46%). From 2000 to 2012,

5760-611: The Affordable Care Act, states are required to continue current Medicaid and CHIP eligibility; however, they are not required to expand Medicaid. The Supreme Court decided in 2012 that the federal government may offer incentives for states to expand Medicaid but may not mandate such expansions. The number of states that will extend Medicaid coverage to individuals below 133 percent of the federal poverty level in January 2014 or thereafter remains uncertain. Overall, states’ decisions relative to Medicaid expansion are an important component of

5888-469: The Diseases but of single Parts, it must needs be a barren Profession to confine unto that of drawing of Teeth, and little better than to have been Tooth-drawer unto King Pyrrhus, who had but two in his Head. The French surgeon Pierre Fauchard became known as the "father of modern dentistry". Despite the limitations of the primitive surgical instruments during the late 17th and early 18th century, Fauchard

6016-695: The EPSDT screen is based on the Bright Futures guidelines for well child visits developed by the American Academy of Pediatrics and federal Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services. The schedules for periodic well-child visits in EPSDT are known as periodicity schedules. States are required to develop schedules for periodic screening, vision, and hearing services at intervals that meet reasonable standards of medical practice. Federal law requires that states consult with recognized medical organizations involved in child health care in

6144-617: The Federal government, although states would need to pay for 10% of those costs by 2020. However, in 2012, the Supreme Court held in National Federation of Independent Business v. Sebelius that withdrawing all Medicaid funding from states that refused to expand eligibility was unconstitutionally coercive. States could choose to maintain pre-existing levels of Medicaid funding and eligibility, and some did; over half

6272-501: The Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services. From the beginning, EPSDT and Title V were linked in federal statute. Simultaneous amendments to Medicaid and Title V law were added in 1967 to create the framework for EPSDT. Between 1967 and 1989, Congress enacted a number of amendments to Title V, adding requirements to work closely with and assist Medicaid in

6400-736: The Medicaid expansion, did not see a similar improvement during the same period. Kentucky opted for increased managed care, while Arkansas subsidized private insurance. Later, Arkansas and Kentucky governors proposed reducing or modifying their programs. From 2013 to 2015, the uninsured rate dropped from 42% to 14% in Arkansas and from 40% to 9% in Kentucky, compared with 39% to 32% in Texas. A 2016 DHHS study found that states that expanded Medicaid had lower premiums on exchange policies because they had fewer low-income enrollees, whose health, on average,

6528-567: The National Bureau of Economic Research (NBER) indicated that states enacting Medicaid expansion exhibited statistically significant reductions in mortality rates. The ACA was structured with the assumption that Medicaid would cover anyone making less than 133% of the Federal poverty level throughout the United States; as a result, premium tax credits are only available to individuals buying private health insurance through exchanges if they make more than that amount. This has given rise to

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6656-461: The PPACA expansion, including coverage for eligible seniors or disabled. These other requirements include, but are not limited to, assets, age, pregnancy, disability, blindness, income, and resources, and one's status as a U.S. citizen or a lawfully admitted immigrant . As of 2015, asset tests varied; for example, eight states did not have an asset test for a buy-in available to working people with disabilities, and one state had no asset test for

6784-835: The Paleolithic, around 13,000 years ago, points to bitumen used to fill a tooth and in Neolithic Slovenia, 6500 years ago, beeswax was used to close a fracture in a tooth. The Indus valley has yielded evidence of dentistry being practised as far back as 7000 BC, during the Stone Age . The Neolithic site of Mehrgarh (now in Pakistan's south western province of Balochistan ) indicates that this form of dentistry involved curing tooth related disorders with bow drills operated, perhaps, by skilled bead-crafters. The reconstruction of this ancient form of dentistry showed that

6912-499: The Royal College of Surgeons (Edinburgh), raising dentistry onto a par with clinical surgery for the first time. Long term occupational noise exposure can contribute to permanent hearing loss, which is referred to as noise-induced hearing loss (NIHL) and tinnitus . Noise exposure can cause excessive stimulation of the hearing mechanism, which damages the delicate structures of the inner ear. NIHL can occur when an individual

7040-551: The Social Security Act of 1935 and became effective on January 1, 1991. This program was formed due to the costs that Medicaid programs were paying for discount price outpatient drugs. The Omnibus Budget Reconciliation Act of 1993 (OBRA-93) amended Section 1927 of the Act, bringing changes to the Medicaid Drug Rebate Program. It requires states to implement a Medicaid estate recovery program to recover from

7168-609: The UK than there were in 1921. It was between 1650 and 1800 that the science of modern dentistry developed. The English physician Thomas Browne in his A Letter to a Friend ( c.  1656 pub. 1690) made an early dental observation with characteristic humour: The Egyptian Mummies that I have seen, have had their Mouths open, and somewhat gaping, which affordeth a good opportunity to view and observe their Teeth, wherein 'tis not easie to find any wanting or decayed: and therefore in Egypt, where one Man practised but one Operation, or

7296-536: The US Government Accountability Office , which has conducted a series of studies of EPSDT over the years. In a 2010 report, the U.S. Health and Human Services Inspector General found that three out of four children did not receive all required medical, vision and hearing screenings under EPSDT. Moreover, nearly 60 percent of the children in selected states who had an EPSDT screening visit did not receive all five required components of

7424-804: The United Kingdom became fully regulated with the 1921 Dentists Act, which required the registration of anyone practising dentistry. The British Dental Association , formed in 1880 with Sir John Tomes as president, played a major role in prosecuting dentists practising illegally. Dentists in the United Kingdom are now regulated by the General Dental Council . In many countries, dentists usually complete between five and eight years of post-secondary education before practising. Though not mandatory, many dentists choose to complete an internship or residency focusing on specific aspects of dental care after they have received their dental degree. In

7552-635: The United Kingdom, the first dental schools, the London School of Dental Surgery and the Metropolitan School of Dental Science, both in London, opened in 1859. The British Dentists Act of 1878 and the 1879 Dentists Register limited the title of "dentist" and "dental surgeon" to qualified and registered practitioners. However, others could legally describe themselves as "dental experts" or "dental consultants". The practice of dentistry in

7680-773: The United States undergo at least three years of undergraduate studies, but nearly all complete a bachelor's degree. This schooling is followed by four years of dental school to qualify as a " Doctor of Dental Surgery " (DDS) or " Doctor of Dental Medicine " (DMD). Specialization in dentistry is available in the fields of Anesthesiology, Dental Public Health, Endodontics, Oral Radiology, Oral and Maxillofacial Surgery, Oral Medicine, Orofacial Pain, Pathology, Orthodontics, Pediatric Dentistry (Pedodontics), Periodontics, and Prosthodontics. Some dentists undertake further training after their initial degree in order to specialize. Exactly which subjects are recognized by dental registration bodies varies according to location. Examples include: Tooth decay

7808-841: The United States, providing free health insurance to 85 million low-income and disabled people as of 2022; in 2019, the program paid for half of all U.S. births. As of 2017, the total annual cost of Medicaid was just over $ 600 billion, of which the federal government contributed $ 375 billion and states an additional $ 230 billion. States are not required to participate in the program, although all have since 1982. In general, Medicaid recipients must be U.S. citizens or qualified non-citizens, and may include low-income adults, their children, and people with certain disabilities . As of 2022 45% of those receiving Medicaid or CHIP were children. Medicaid also covers long-term services and supports, including both nursing home care and home- and community-based services, for those with low incomes and minimal assets;

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7936-972: The United States. The U.S. Centers for Medicare & Medicaid Services in Baltimore , Maryland provides federal oversight. Research shows that existence of the Medicaid program improves health outcomes, health insurance coverage, access to health care, and recipients' financial security and provides economic benefits to states and health providers. Medicaid expansion has enhanced access to healthcare services. Studies have shown improved self-reported health following expansion and an association between expansion and certain positive health outcomes. Expanding Medicaid has been associated with significant declines in mortality related to specific conditions, including various types of cancer, cardiovascular disease, and liver disease. Additionally, studies have found decreased maternal mortality and, in some cases, reductions in infant mortality among certain populations. Beginning in

8064-538: The aged/blind/disabled pathway up to 100% of the Federal Poverty Level . Dentistry Dentistry , also known as dental medicine and oral medicine , is the branch of medicine focused on the teeth , gums , and mouth . It consists of the study, diagnosis , prevention, management, and treatment of diseases , disorders, and conditions of the mouth, most commonly focused on dentition (the development and arrangement of teeth) as well as

8192-402: The areas of maternal and child health and Medicaid. The members of the group provided advice to help CMS identify key opportunities for improvement of EPSDT. The group, which meets periodically, also discussed steps that the federal government might take in partnership with states and private sector organizations to both increase the number of children accessing services, and improve the quality of

8320-523: The associated scientific study of teeth is odontology (from Ancient Greek : ὀδούς , romanized :  odoús , lit.   'tooth') – the study of the structure, development, and abnormalities of the teeth. Dentistry usually encompasses practices related to the oral cavity. According to the World Health Organization , oral diseases are major public health problems due to their high incidence and prevalence across

8448-665: The average difference in reimbursement for 10 common orthopedic procedures in the states of New Jersey and Delaware was $ 3,047. The discrepancy in the reimbursements Medicaid offers may affect the type of care provided to patients. In general, Medicaid plans pay providers significantly less than commercial insurers or Medicare would pay for the same care, paying around 67% as much as Medicare would for primary care and 78% as much for other services. This disparity has been linked to lower provider rates of participation in Medicaid programs vs Medicare or commercial insurance, and thus decreased access to care for Medicaid patients. One component of

8576-498: The chances of a successful tooth transplant (initially, at least) would be improved if the donor tooth was as fresh as possible and was matched for size with the recipient. These principles are still used in the transplantation of internal organs . Hunter conducted a series of pioneering operations, in which he attempted a tooth transplant. Although the donated teeth never properly bonded with the recipients' gums, one of Hunter's patients stated that he had three which lasted for six years,

8704-514: The cost of expansion was $ 6,366 per person for 2015, about 49 percent above previous estimates. An estimated 9 to 10 million people had gained Medicaid coverage, mostly low-income adults. The Kaiser Family Foundation estimated in October 2015 that 3.1 million additional people were not covered in states that rejected the Medicaid expansion. In some states that chose not to expand Medicaid, income eligibility thresholds are significantly below 133% of

8832-592: The cost of living in a nursing home for those who are eligible; the recipient also pays most of his/her income toward the nursing home costs, usually keeping only $ 66.00 a month for expenses other than the nursing home. Some states operate a program known as the Health Insurance Premium Payment Program (HIPP). This program allows a Medicaid recipient to have private health insurance paid for by Medicaid. As of 2008 relatively few states had premium assistance programs and enrollment

8960-508: The cost of private coverage. Certain groups of people, such as migrants, face more barriers to health care than others due to factors besides policy, such as status, transportation and knowledge of the healthcare system (including eligibility). Medicaid eligibility policies are very complicated. In general, a person's Medicaid eligibility is linked to their eligibility for Aid to Families with Dependent Children (AFDC), which provides aid to children whose families have low or no income, and to

9088-455: The dBA level increases. Within the field of dentistry, a variety of cleaning tools are used including piezoelectric and sonic scalers, and ultrasonic scalers and cleaners. While a majority of the tools do not exceed 75 dBA, prolonged exposure over many years can lead to hearing loss or complaints of tinnitus. Few dentists have reported using personal hearing protective devices, which could offset any potential hearing loss or tinnitus. There

9216-713: The development of their states’ EPSDT periodicity schedules. Alternatively, states may elect to use a nationally recognized pediatric periodicity schedule such as Bright Futures . A separate children’s dental periodicity schedule is also required. One has been developed by the American Academy of Pediatric Dentistry. Improving periodicity schedules can improve access to and utilization of child health services. EPSDT also provides coverage for treatment. All types of child health conditions — medical, dental, mental, developmental, acute, and chronic — must be treated, including pre-existing conditions or those detected outside of an EPSDT comprehensive well-child “screening” visit. EPSDT coverage

9344-481: The development or worsening of conditions, illnesses, and disabilities. Dental services must meet standards of dental practice . These standards should be determined by the state following discussion regarding the health of the child. Minimum services should include pain relief , restoration of teeth and maintenance for dental health. EPSDT individuals below the age of 21 are not to be limited emergency services. Medical care providers should provide direct referral to

9472-465: The eruption pattern of teeth, treating decayed teeth and gum disease, extracting teeth with forceps , and using wires to stabilize loose teeth and fractured jaws. Use of dental appliances, bridges and dentures was applied by the Etruscans in northern Italy, from as early as 700 BC, of human or other animal teeth fastened together with gold bands. The Romans had likely borrowed this technique by

9600-472: The estate of deceased beneficiaries the long-term-care-related costs paid by Medicaid, and gives states the option of recovering all non-long-term-care costs, including full medical costs. Medicaid also offers a Fee for Service (Direct Service) Program to schools throughout the United States for the reimbursement of costs associated with the services delivered to students with special education needs. Federal law mandates that children with disabilities receive

9728-422: The exact qualifications vary by state. Medicaid spent $ 215 billion on such care in 2020, over half of the total $ 402 billion spent on such services. Of the 7.7 million Americans who used long-term services and supports in 2020, about 5.6 million were covered by Medicaid, including 1.6 million of the 1.9 million in institutional settings. Medicaid covers healthcare costs for people with low incomes, while Medicare

9856-572: The federal level and focuses primarily on the older population. Medicare is a health insurance program for people age 65 or older, people under age 65 with certain disabilities, and (through the End Stage Renal Disease Program ) people of all ages with end-stage renal disease . The Medicare Program provides a Medicare part A covering hospital bills, Medicare Part B covering medical insurance coverage, and Medicare Part D covering purchase of prescription drugs . Medicaid

9984-426: The form of waivers for certain Medicaid requirements so long as they follow certain objectives. In its implementation, this has meant using Medicaid funds to pay for low-income citizens' health insurance; this private-option was originally carried out in Arkansas but was adopted by other Republican-led states. However, private coverage is more expensive than Medicaid and the states would not have to contribute as much to

10112-497: The generalized hypothesis that Democrats favor generous eligibility policies while Republicans do not. When the Supreme Court allowed states to decide whether to expand Medicaid or not in 2012, northern states, in which Democratic legislators predominated, disproportionately did so, often also extending existing eligibility. Certain states in which there is a Republican-controlled legislature may be forced to expand Medicaid in ways extending beyond increasing existing eligibility in

10240-555: The globe, with the disadvantaged affected more than other socio-economic groups. The majority of dental treatments are carried out to prevent or treat the two most common oral diseases which are dental caries (tooth decay) and periodontal disease (gum disease or pyorrhea). Common treatments involve the restoration of teeth , extraction or surgical removal of teeth, scaling and root planing , endodontic root canal treatment, and cosmetic dentistry By nature of their general training, dentists, without specialization can carry out

10368-551: The latest procedures and patients to receive improved treatment. A new paradigm for medical education designed to incorporate current research into education and practice was developed to help practitioners provide the best care for their patients. It was first introduced by Gordon Guyatt and the Evidence-Based Medicine Working Group at McMaster University in Ontario, Canada in the 1990s. It

10496-483: The law to comprehensive preventive and restorative dental services, but dental care utilization for this population is low. The reasons for low use are many, but a lack of dental providers who participate in Medicaid is a key factor. Few dentists participate in Medicaid – less than half of all active private dentists in some areas. Cited reasons for not participating are low reimbursement rates, complex forms and burdensome administrative requirements. In Washington state,

10624-429: The law was passed, some states did not allow able-bodied adults to participate in Medicaid, and many set income eligibility far below the Federal poverty level. Under the provisions of the law, any state that participated in Medicaid would need to expand coverage to include anyone earning up to 138% of the Federal poverty level beginning in 2014. The costs of the newly covered population would initially be covered in full by

10752-584: The majority of dental treatments such as restorative (fillings, crowns , bridges ), prosthetic ( dentures ), endodontic (root canal) therapy, periodontal (gum) therapy, and extraction of teeth, as well as performing examinations, radiographs (x-rays), and diagnosis. Dentists can also prescribe medications used in the field such as antibiotics , sedatives , and any other drugs used in patient management. Depending on their licensing boards, general dentists may be required to complete additional training to perform sedation, dental implants, etc. Dentists also encourage

10880-497: The man and damage the next generation. Our nation must rid itself of this bitter inheritance. Our goal must be clear--to give every child the chance to fulfill his promise.” Another set of arguments in support of EPSDT was in a report on young men found unqualified for military service, which concluded that the majority of those rejected for service in the early 1960s failed as a result of physical and mental health conditions which might have been prevented or treated in childhood. Over

11008-570: The methods used were reliable and effective. The earliest dental filling , made of beeswax , was discovered in Slovenia and dates from 6500 years ago. Dentistry was practised in prehistoric Malta , as evidenced by a skull which had a dental abscess lanced from the root of a tooth dating back to around 2500 BC. An ancient Sumerian text describes a " tooth worm " as the cause of dental caries . Evidence of this belief has also been found in ancient India, Egypt , Japan, and China. The legend of

11136-616: The more popular implementation approach, in large part because the funding for each state is limited and does not provide for an entitlement. Under the Patient Protection and Affordable Care Act Medicaid is expanded, particularly for adults. Only a small proportion of children are uninsured, an estimate 5-7 million. About half of the children currently uninsured are eligible for Medicaid or CHIP coverage but have not been enrolled in these programs. In some cases, eligible children are not enrolled because their parents are unaware of

11264-459: The mouth to inspect teeth deformity or oral malaises, haematology (study of blood) to avoid bleeding complications during dental surgery, cardiology (due to various severe complications arising from dental surgery with patients with heart disease), etc. The term dentistry comes from dentist , which comes from French dentiste , which comes from the French and Latin words for tooth. The term for

11392-632: The national average per capita annual cost of Medicaid services for children to be $ 2,577, adults to be $ 3,278, persons with disabilities to be $ 16,859, aged persons (65+) to be $ 13,063, and all Medicaid enrollees to be $ 5,736. The Social Security Amendments of 1965 created Medicaid by adding Title XIX to the Social Security Act , 42 U.S.C. §§ 1396 et seq. Under the program, the federal government provided matching funds to states to enable them to provide Medical Assistance to residents who met certain eligibility requirements. The objective

11520-510: The national health reform plan. Medicaid In the United States , Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides

11648-620: The national uninsured population lives in those states. As of March 2023, 40 states have accepted the Affordable Care Act Medicaid extension, as has the District of Columbia , which has its own Medicaid program; 10 states have not. Among adults aged 18 to 64, states that expanded Medicaid had an uninsured rate of 7.3% in the first quarter of 2016, while non-expansion states had a 14.1% uninsured rate. The Centers for Medicare and Medicaid Services (CMS) estimated that

11776-574: The needs of children with special needs. This includes children with special health care needs, with mental conditions and disorders, those in foster care, adolescents in transition to adulthood, and infants and toddlers whose risks point to future health or developmental problems. In December 2010, the Centers for Medicare and Medicaid Services (CMS) convened a National EPSDT Improvement Workgroup that included state representatives, children’s health providers, consumer representatives, and other experts in

11904-619: The occlusal guidance of the teeth; this principle is still valid in modern times. Al-Zahrawi invented over 200 surgical tools that resemble the modern kind. Historically, dental extractions have been used to treat a variety of illnesses. During the Middle Ages and throughout the 19th century, dentistry was not a profession in itself, and often dental procedures were performed by barbers or general physicians . Barbers usually limited their practice to extracting teeth which alleviated pain and associated chronic tooth infection . Instruments used for dental extractions date back several centuries. In

12032-469: The past 40 years, federal EPSDT law has been amended and state efforts have evolved to match changes in standards of pediatric care, structures in the health care system, and our understanding of the physical, emotional, and developmental needs of low-income children. The amendments of 1989 clarified and broadened coverage to include all necessary diagnostic and treatment services approved under federal law. The politics of EPSDT remain controversial. Some view

12160-466: The population was enrolled in Medi-Cal for at least 1 month in 2009–10. As of 2017, the total annual cost of Medicaid was just over $ 600 billion, of which the federal government contributed $ 375 billion and states an additional $ 230 billion. According to CMS, the Medicaid program provided health care services to more than 92 million people in 2022. Loss of income and medical insurance coverage during

12288-469: The potential coverage or are reluctant to apply for public benefits. Researchers at the Urban Institute estimate that, with full implementation of the health reforms contained in the Affordable Care Act, the number of uninsured children would be cut by 40 percent and the number of uninsured parents cut in half. The actual impact will depend on states’ implementation of Medicaid expansions. Under

12416-582: The potential to connect families to appropriate and needed services. By strengthening the linkages between primary health care providers and other child and family services, case management and care coordination can better ensure that children receive needed services on a timely basis. Without these supports, children and families are more likely to delay or not receive services to address risks and prevent conditions from worsening. This work often demands strengthening state interagency partnerships. Fifth, designing policies and delivery system structures that address

12544-446: The poverty line were eligible for Medicaid, those with incomes from 32% to 100% of the poverty level ($ 6,250 to $ 19,530 for a family of three) were ineligible for both Medicaid and federal subsidies to buy insurance. Studies of the impact of Medicaid expansion rejections calculated that up to 6.4 million people would have too much income for Medicaid but not qualify for exchange subsidies. Several states argued that they could not afford

12672-464: The poverty line. Some of these states do not make Medicaid available to non-pregnant adults without disabilities or dependent children, no matter their income. Because subsidies on commercial insurance plans are not available to such individuals, most have few options for obtaining any medical insurance. For example, in Kansas , where only non-disabled adults with children and with an income below 32% of

12800-550: The prevention of oral diseases through proper hygiene and regular, twice or more yearly, checkups for professional cleaning and evaluation. Oral infections and inflammations may affect overall health and conditions in the oral cavity may be indicative of systemic diseases, such as osteoporosis , diabetes , celiac disease or cancer . Many studies have also shown that gum disease is associated with an increased risk of diabetes, heart disease , and preterm birth . The concept that oral health can affect systemic health and disease

12928-539: The process more effective. EPSDT also finances diagnostic and treatment services, if medically necessary, for these conditions. Some states contract with managed care organizations or community mental health centers to deliver certain Medicaid financed services for children, and in other states Medicaid financing for children’s mental health services is administered by state mental health agencies. Federal law requires that children under age 21 who are enrolled in Medicaid be entitled to EPSDT benefits and that States must cover

13056-409: The program as well designed and structured to meet child health needs, fitting professional guidelines and standards and focusing on prevention and optimal development. Others view the sweeping coverage as too generous for public coverage. As a result, the EPSDT benefit is guaranteed only for children with Medicaid coverage and not under other federal programs (see discussion below of CHIP). EPSDT, as

13184-571: The proportion of hospital stays for children paid by Medicaid increased by 33% and the proportion paid by private insurance decreased by 21%. Some 43 million Americans were enrolled in 2004 (19.7 million of them children) at a total cost of $ 295 billion. In 2008, Medicaid provided health coverage and services to approximately 49 million low-income children, pregnant women, elderly people, and disabled people. In 2009, 62.9 million Americans were enrolled in Medicaid for at least one month, with an average enrollment of 50.1 million. In California , about 23% of

13312-599: The quality and structure of services. Quality improvement projects and efforts to accurately measure program performance are important. Equally important is maximizing the available health professionals, including an array of physicians, nurses, and other in the delivery of EPSDT services. Use of a medical/health home and creation of integrated delivery systems also has shown promise for improving child outcomes, particularly for children with special health needs and chronic or disabling conditions. Fourth, states’ use of case management and other mechanisms to coordinate services have

13440-551: The range and depth of Medicaid coverage for infants, children, and adolescents. President Johnson’s concern for the well-being of poor children was one political force. In 1967, as he transmitted his program for America’s children and youth, President Johnson said: “Recent studies confirm what we have long suspected. In education, in health, in all of human development, the early years are the critical years. Ignorance, ill health, personality disorder--these are disabilities often contracted in childhood: afflictions which linger to cripple

13568-612: The range of services covered. Federal law requires that states adequately inform parents about the benefits of EPSDT. Some states’ communications with parents have often focused primarily on screening and provided limited information regarding the range of treatment and intervention services that may be covered when medically necessary. In particular, offering training, clear provider manuals, specific website content, and routine communication can assist providers in delivering high-quality well-child visits financed through EPSDT, as well as visits financed by other payer sources. Third, improving

13696-424: The recovery is limited to probate estates or extends beyond.) Several political factors influence the cost and eligibility of tax-funded health care. According to a study conducted by Gideon Lukens, factors significantly affecting eligibility included "party control, the ideology of state citizens, the prevalence of women in legislatures, the line-item veto, and physician interest group size". Lukens' study supported

13824-623: The same basic framework. As of 2013, Medicaid is a program intended for those with low income, but a low income is not the only requirement to enroll in the program. Eligibility is categorical —that is, to enroll one must be a member of a category defined by statute; some of these categories are: low-income children below a certain wage, pregnant women, parents of Medicaid-eligible children who meet certain income requirements, low-income disabled people who receive Supplemental Security Income (SSI) and/or Social Security Disability (SSD), and low-income seniors 65 and older. The details of how each category

13952-1442: The same organization that handles Medicaid in a state may also manage the additional programs. Separate programs may also exist in some localities that are funded by the states or their political subdivisions to provide health coverage for indigents and minors. State participation in Medicaid is voluntary; however, all states have participated since 1982. In some states Medicaid is subcontracted to private health insurance companies, while other states pay providers (i.e., doctors, clinics and hospitals) directly. There are many services that can fall under Medicaid and some states support more services than other states. The most provided services are intermediate care for mentally disabled, prescription drugs and nursing facility care for under 21-year-olds. The least provided services include institutional religious (non-medical) health care, respiratory care for ventilator dependent and PACE (inclusive elderly care ). Most states administer Medicaid through their own programs. A few of those programs are listed below: As of January 2012, Medicaid and/or CHIP funds could be obtained to help pay employer health care premiums in Alabama , Alaska , Arizona, Colorado , Florida , and Georgia . States must comply with federal law, under which each participating state administers its own Medicaid program, establishes eligibility standards, determines

14080-408: The saving on to patients currently without adequate dental care. While Congress and the Centers for Medicare and Medicaid Services (CMS) set out the general rules under which Medicaid operates, each state runs its own program. Under certain circumstances, an applicant may be denied coverage. As a result, the eligibility rules differ significantly from state to state, although all states must follow

14208-684: The scope and types of services it will cover, and sets the rate of reimbursement physicians and care providers. Differences between states are often influenced by the political ideologies of the state and cultural beliefs of the general population. The federal Centers for Medicare and Medicaid Services (CMS) closely monitors each state's program and establishes requirements for service delivery, quality, funding, and eligibility standards. Medicaid estate recovery regulations also vary by state. (Federal law gives options as to whether non-long-term-care-related expenses, such as normal health-insurance-type medical expenses are to be recovered, as well as on whether

14336-505: The service must be justified as reasonable, necessary, and/or appropriate, using evidence-based clinical standards of care. For children, federal Medicaid law requires coverage of “necessary health care, diagnostic services, treatment, and other measures . . . to correct or ameliorate defects and physical and mental illnesses and conditions.” Thus, the EPSDT medical necessity standard assures a level of coverage sufficient not only to treat an already-existing illness or injury but also to prevent

14464-475: The so-called Medicaid coverage gap in states that have not expanded Medicaid: there are people whose income is too high to qualify for Medicaid in those states, but too low to receive assistance in paying for private health insurance, which is therefore unaffordable to them. States may bundle together the administration of Medicaid with other programs such as the Children's Health Insurance Program (CHIP), so

14592-923: The state and at other intervals as medically necessary. At a minimum, hearing services include diagnosis and treatment for defects in hearing, including hearing aids. Speech, language, and hearing services are related and are covered when medically necessary. Children’s mental health services are an integral part of the design and scope of EPSDT. From behavioral/social/emotional screening tests as part of EPSDT well-child visits, to diagnosis, to treatment, and systems of care, Medicaid and EPSDT are critical to financing evidence-based mental health services for children. Federal law requires comprehensive well-child examinations with screening services through EPSDT, including screening for potential developmental, mental, behavioral, and/or substance use disorders. Where states choose, requiring providers to use objective and standardized tools to assess mental/behavioral/social/emotional health make

14720-405: The teeth and in the gums could appear in the later stages of tooth decay. Fauchard was the pioneer of dental prosthesis , and he invented many methods to replace lost teeth. He suggested that substitutes could be made from carved blocks of ivory or bone . He also introduced dental braces , although they were initially made of gold, he discovered that the teeth position could be corrected as

14848-433: The teeth would follow the pattern of the wires. Waxed linen or silk threads were usually employed to fasten the braces. His contributions to the world of dental science consist primarily of his 1728 publication Le chirurgien dentiste or The Surgeon Dentist. The French text included "basic oral anatomy and function, dental construction, and various operative and restorative techniques, and effectively separated dentistry from

14976-514: The treatment of dislocated or fractured jaws. In the 18th century BC, the Code of Hammurabi referenced dental extraction twice as it related to punishment. Examination of the remains of some ancient Egyptians and Greco-Romans reveals early attempts at dental prosthetics . However, it is possible the prosthetics were prepared after death for aesthetic reasons. Ancient Greek scholars Hippocrates and Aristotle wrote about dentistry, including

15104-475: The use of high-quality scientific research and evidence to guide decision-making such as in manual tooth conservation, use of fluoride water treatment and fluoride toothpaste, dealing with oral diseases such as tooth decay and periodontitis , as well as systematic diseases such as osteoporosis , diabetes , celiac disease , cancer , and HIV/AIDS which could also affect the oral cavity. Other practices relevant to evidence-based dentistry include radiology of

15232-484: The vision of President Johnson and the Congress in order "to discover, as early as possible, the ills that handicap our children" and to provide "continuing follow up and treatment so that handicaps do not go neglected." While children were eligible for Medicaid from its original enactment in 1965, no specific standards related to child health coverage were included. Within two years, however, policymakers would focus on

15360-684: The visit. Lab tests were most often missing. By promoting and vigorously implementing the EPSDT program and its various components, states can improve the quality of health care, reduce the prevalence of preventable conditions, and have measurable impact. A series of 18 state leadership workshops on EPSDT identified key actions states can take to improve services, coordination, and administration. State reports, research, and federal recommendations together point to several general approaches that states can use to reduce barriers and improve EPSDT. These are beyond efforts to ensure that eligible children are enrolled in Medicaid, and, where appropriate, connected to

15488-583: The wider category of surgery". After Fauchard, the study of dentistry rapidly expanded. Two important books, Natural History of Human Teeth (1771) and Practical Treatise on the Diseases of the Teeth (1778), were published by British surgeon John Hunter . In 1763, he entered into a period of collaboration with the London-based dentist James Spence. He began to theorise about the possibility of tooth transplants from one person to another. He realised that

15616-683: The worm is also found in the Homeric Hymns , and as late as the 14th century AD the surgeon Guy de Chauliac still promoted the belief that worms cause tooth decay. Recipes for the treatment of toothache, infections and loose teeth are spread throughout the Ebers Papyrus , Kahun Papyri , Brugsch Papyrus , and Hearst papyrus of Ancient Egypt . The Edwin Smith Papyrus , written in the 17th century BC but which may reflect previous manuscripts from as early as 3000 BC, discusses

15744-412: Was a highly skilled surgeon who made remarkable improvisations of dental instruments, often adapting tools from watchmakers , jewelers and even barbers , that he thought could be used in dentistry. He introduced dental fillings as treatment for dental cavities . He asserted that sugar -derived acids like tartaric acid were responsible for dental decay , and also suggested that tumors surrounding

15872-518: Was called "Operator for the Teeth" by Charles Allen in 1685. In the United Kingdom, there was no formal qualification for the providers of dental treatment until 1859 and it was only in 1921 that the practice of dentistry was limited to those who were professionally qualified. The Royal Commission on the National Health Service in 1979 reported that there were then more than twice as many registered dentists per 10,000 population in

16000-446: Was created in 1997 and reauthorized in 2009. Known as CHIP, the program was enacted following the 1994 failure of national health reform. The purpose of CHIP was to expand health insurance coverage for targeted, uninsured, low-income children with family incomes below 200 percent of the federal poverty level. The program provides states with federal funding to expand health insurance beyond Medicaid eligibility levels. In some states, CHIP

16128-502: Was low in pre-agricultural societies, but the advent of farming society about 10,000 years ago correlated with an increase in tooth decay (cavities). An infected tooth from Italy partially cleaned with flint tools, between 13,820 and 14,160 years old, represents the oldest known dentistry, although a 2017 study suggests that 130,000 years ago the Neanderthals already used rudimentary dentistry tools. In Italy evidence dated to

16256-520: Was relatively low. Interest in this approach remained high, however. Included in the Social Security program under Medicaid are dental services . Registration for dental services is optional for people older than 21 years but required for people eligible for Medicaid and younger than 21. Minimum services include pain relief, restoration of teeth and maintenance for dental health. Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

16384-524: Was to help states assist residents whose income and resources were insufficient to pay the costs of traditional commercial health insurance plans. By 1982, all states were participating. The last state to do so was Arizona. The Medicaid Drug Rebate Program and the Health Insurance Premium Payment Program (HIPP) were created by the Omnibus Budget Reconciliation Act of 1990 (OBRA-90). This act helped to add Section 1927 to

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