Incentivizing Oral Healthcare Providers to Treat Patients with Intellectual & Developmental Disabilities

Background and Statement of ProblemA significant oral health disparity exists for people with I/DD.

Studies have shown that adults with developmental disabilities are at risk for multiple health problems including poor oral health.

Further, in 2002, the U. S. Surgeon General reported that,


compared with other populations, “adults, adolescents, and children with [intellectual disability (sic)] experience poorer health and more difficulty in finding, getting to, and paying for appropriate health care.” This disparity has made people with I/DD more likely to have poor oral hygiene, periodontal disease and untreated dental caries than members of the general population.

Equally noteworthy is the comprehensible frustration and sense of injustice this disparity creates, a disparity created in part by an insufficient number of oral healthcare providers willing to treat patients with I/DD through Medicaid.Approximately 60 percent of people in the United States with I/DD rely on Medicaid for their health insurance coverage; and effective coverage is no doubt dependent on a sufficient number of providers willing to participate in the program and provide preventive treatment to patients with I/DD.

There were about two million annual emergency department visits in the United States for nontraumatic dental problems, representing 1. 5% of all emergency department visits, as of 201 5. People with I/DD tend to have higher rates of emergency department visits when compared with people that do not have I/DD.

Increasing the number of providers participating in Medicaid programs that provide preventive oral healthcare services to patients with I/DD decreases the need of this patient population to take the more arduous route of obtaining oral healthcare in emergency departments.Since 2017, NCD has focused on achieving improved access to oral healthcare for people with intellectual and developmental disabilities.

Through analysis conducted by NCD preceding this project, NCD found that there would be a return-on-investment for states that do not currently provide non-emergency Medicaid oral healthcare coverage for people with I/DD through healthcare cost savings that would largely exceed the cost of providing preventive services through Medicaid.

In 2017, with publication of its policy brief, Neglected for Too Long:
Dental Care for People with Intellectual and Developmental Disabilities, NCD outlined areas through which access to improved oral health can be achieved.

Those areas included required training for dental students to manage treatment of patients with I/DD, and changing the American Dental Association’s Code of Professional Conduct to stipulate that dentists may not deny treatment to a patient based on the patient’s disability status and referring the patient to a provider able to provide treatment when necessary.Many of the policy recommendations NCD has made in the space of oral healthcare for patients with I/DD have been implemented.

The American Dental Association has revised its professional code to state that a provider may not deny care to a patient based on a patient's disability, and the Commission on Dental Accreditation now requires all US dental schools to train students to manage treatment of patients with I/DD.

Determining what programs might incentivize providers to treat patients with I/DD through Medicaid is a vital component of achieving best approaches towards realizing the policy proposal of improving access to oral health preventive care for patients with I/DD.

Statement of WorkFor this project a questionnaire will be disseminated to oral healthcare providers to determine why more providers do not participate in Medicaid programs and waivers that allow for the treatment of patients with I/DD.

The questionnaire will further query oral healthcare providers about potential incentives that could rectify that problem.

Additionally, the report will establish a method by which states could potentially calculate a comprehensive return-on-investment for investments that result in increased provider participation that go beyond healthcare costs savings, including but not limited to savings across all respective state departments and programs, and additional state-wide economic concerns and benefits.

The Report will address the following:
• Query oral healthcare providers that formerly participated in Medicaid programs and waivers that facilitate the treatment of patients with I/DD as to why they no longer do.• Query oral healthcare providers as to whether low Medicaid reimbursement rates disincentivize them from participation in the treatment of patients with I/DD through Medicaid and, if so, inquire as to what rate might serve as a sufficient incentive.

• Query oral healthcare providers that have in the past and still do participate in Medicaid programs and waivers as to why they continue to participate.• Query non-participating oral healthcare providers concerning what policies would incentivize them to participate in providing care to patients with I/DD through Medicaid and related waivers.• Determine in which states, if any, is information concerning Medicaid Managed Care Organizations’ reimbursement rates available?• Determine an optimal formula for states to use to analyze a return on investment for programs that incentivize oral healthcare providers to treat patients with I/DD through participation in Medicaid that go beyond just the healthcare costs saved due to an increase in preventive oral healthcare (including but not limited to savings across state departments and programs and additional state-wide economic concerns and benefits).Time PeriodSix months

Office: National Council on Disability

Estimated Funding: $30,000,000

Who's Eligible

Obtain Full Opportunity Text:
NCD Website

Additional Information of Eligibility:
Other Eligible Applicants include the following: Alaska Native and Native Hawaiian Serving Institutions; Eligible Agencies of the Federal Government; Faith-based or Community-based Organizations; Hispanic-serving Institutions; Historically Black Colleges and Universities (HBCUs); Indian/Native American Tribal Governments (Other than Federally Recognized); Non-domestic (non-U.S.) Entities (Foreign Organizations); Regional Organizations; Tribally Controlled Colleges and Universities (TCCUs) ; U. S. Territory or Possession; Non-domestic (non-U.S.) Entities (Foreign Institutions) are eligible to apply.

Non-domestic (non-U.S.) components of U. S. Organizations are eligible to apply.

Foreign components, as defined in the NIH Grants Policy Statement, are allowed.

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