the oral health status of florida’s...
TRANSCRIPT
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The Oral Health Status of Florida’s Children
Scott L. Tomar, DMD, DrPH
University of Florida College of Dentistry
Oral Health Florida Conference, Orlando, July 28, 2017
Learning Objectives
• Describe recent trends in access to oral health services by children in Florida.
• Compare Florida’s status on key oral health indicators with other states.
• Identify 3 challenges to improving the oral health status of Florida’s vulnerable children.
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Florida’s Kids…by the Numbers
• 4.5 million children 0‐18 in Florida (3rd highest in US)
• 25% of Florida’s children live in poverty (7th highest in US)
• 45% of Florida’s children covered by Medicaid (8th highest)
• 5% of children have difficulty speaking English (6th highest)
• Per‐pupil education spending K‐12: $8,881 (10th lowest)
• Per‐capita CDC funding for public health: $19.09 (11th lowest)
Sources:Kaiser Family FoundationUS Census BureauKidsCount.org Trust for America’s Health
% of Medicaid/CHIP eligibles enrolled at least 90 days receiving any dental services
Florida 2010–2015
23.5 22.6
27.028.6 29.4
34.6
0
5
10
15
20
25
30
35
40
2010 2011 2012 2013 2014 2015
Percen
t
Year
Source: CMS 416 EPSDT Reports, FY 2010–2015
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Percentage of Medicaid/CHIP eligible children enrolled at least 90 days receiving any dental service, FY 2015
0
10
20
30
40
50
60
70
Wisconsin
North Dakota
Florida
Ohio
Missouri
South Dakota
Nevada
Michigan
Minnesota
Orego
nMaine
New York
Wyo
ming
California
Montana
Illinois
Pen
nsylvan
iaKan
sas
Rhode Island
NATIONAL
Louisiana
Ken
tucky
Delaware
Idah
oAlaska
Indiana
Arizona
Alabam
aSo
uth Carolin
aMississippi
Tennessee
Oklah
oma
New Jersey
North Carolin
aVirginia
West Virginia
Utah
Arkan
sas
Geo
rgia
Iowa
Colorado
Nebraska
Massachusetts
DC
New M
exico
Marylan
dNew Ham
pshire
Vermont
Washington
Haw
aii
Connecticut
Texas
Percen
t
Florida: 34.6%
National: 47.5%
Data from form CMS‐416. www.medicaid.gov/medicaid/benefits/epsdt/index.html
% of Medicaid/CHIP eligibles enrolled at least 90 days receiving a preventive dental service
Florida 2010–2015
14.0 13.0
18.0
24.026.0
31.0
0
5
10
15
20
25
30
35
2010 2011 2012 2013 2014 2015
Percen
t
Year
Source: CMS 416 EPSDT Reports, FY 2010–2015
4
Percentage of Medicaid/CHIP eligible children enrolled at least 90 days receiving a preventive dental service, FY 2015
0
10
20
30
40
50
60
70
Wisconsin
North Dakota
Florida
Ohio
South Dakota
Illinois
Missouri
Minnesota
Orego
nCalifornia
Nevada
Maine
Montana
Michigan
New York
Wyo
ming
Rhode Island
Pen
nsylvan
iaKen
tucky
NATIONAL
Alaska
Kan
sas
Arizona
West Virginia
Idah
oMississippi
Louisiana
Indiana
Alabam
aOklah
oma
Delaware
Tennessee
Souith Carolin
aNew Jersey
Haw
aii
Colorado
North Carolin
aVirginia
Arkan
sas
Iowa
Geo
rgia
Massachusetts
Utah
New M
exico
Nebraska
Marylan
dDC
Vermont
New Ham
pshire
Washington
Connecticut
Texas
Percen
t
Florida: 31.0%
National: 43.4%
Data from form CMS‐416. www.medicaid.gov/medicaid/benefits/epsdt/index.html
Dentist Participation in Medicaid or CHIPAmerican Dental Association, Health Policy Institute, 2017
FL
5
Medicaid Fee‐for‐Service Reimbursement as Percentage of Private Insurance
Reimbursement, Child Dental Service, 2016
FL
Gupta et at. ADA HPI 2017
Rates* of Dental‐Related Emergency Dept. VisitsAge 5–14 Years, Florida, 2005–2015
213.47
382.13
0.00
50.00
100.00
150.00
200.00
250.00
300.00
350.00
400.00
450.00
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Rate per 100,000
Year
79% rate increase in past decade8,686 visits in 2015
*Per 100,000 populationTomar et al. J Public Health Dent 2016; 76:249‐57. AHCA ED database 2015.
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Florida Department of Health Public Health Dental Program. (2016). The Oral Health Status of Florida’s Third Grade Children 2013‐2014.
Participation rate = 41.4%
Florida Department of Health Public Health Dental Program. (2016). The Oral Health Status of Florida’s Third Grade Children 2013‐2014.
FL: 7th Best
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FL: 11th Worst
Florida Department of Health Public Health Dental Program. (2016). The Oral Health Status of Florida’s Third Grade Children 2013‐2014.
How Do Alachua and Collier Counties Compare to Florida and Other States?
34.5
35.439.6
40.7
40.9
41.3
41.9
43.1
44.1
47.2
47.2
47.3
48.4
48.6
49.5
51.0
51.2
52.0
52.4
52.5
52.6
53.0
53.6
54.7
54.9
55.2
55.8
55.9
56.0
57.5
57.6
59.8
61.6
61.8
62.8
63.8
63.9
64.0
64.0
64.6
64.8
64.9
65.7
66.0
66.870.9
72.5
74.6
Vermont
New
Ham
pshire
Connecticut
Massachusetts
Maine
Marylan
dNorth Carolin
aFLORIDA
New
York
Delaw
are
Virginia
South Carolin
aKan
sas
Rhode Island
Minnesota
Indiana
Ohio
Geo
rgia
Illinois
Wisconsin
Pen
nsylvan
iaWashington
Iowa
Missouri
Michigan
Colorado
ALA
CHUA COUNTY
South Dakota
West Virginia
Orego
nAlabam
aKentucky
Alaska
Idah
oMississippi
COLLIER COUNTY
Neb
raska
Arizona
Arkan
sas
New
Mexico
Montana
Nevad
aLouisiana
Oklah
oma
Texas
California
North Dakota
Utah
Caries Experience in Third Graders (%)
Data from National Oral Health Surveillance System http://www.cdc.gov/oralhealthdata/ and county oral health surveillance systems
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How Do Alachua and Collier Counties Compare to Florida and Other States?
8.29.510.8
11.7
12.0
12.4
13.6
14.3
14.4
15.1
15.6
16.0
16.1
16.6
16.7
17.3
17.8
18.6
18.7
20.8
21.0
21.0
21.3
21.5
21.6
21.7
22.1
22.2
22.4
23.4
23.8
23.9
24.9
25.3
26.2
27.0
27.3
28.0
28.1
28.2
28.7
29.0
30.6
32.034.637.0
37.1
38.541.9
New
Ham
pshire
Kan
sas
Vermont
Connecticut
Washington
South Carolin
aMarylan
dNorth Carolin
aColorado
Virginia
Maine
Iowa
Delaw
are
Minnesota
Indiana
Massachusetts
Wisconsin
Ohio
Geo
rgia
Idah
oUtah
West Virginia
Alabam
aSo
uth Dakota
Orego
nOklah
oma
New
York
Illinois
Haw
aii
FLORIDA
Montana
Alaska
Michigan
Rhode Island
Texas
Missouri
Pen
nsylvan
iaArizona
Nevad
aNorth Dakota
California
Arkan
sas
Mississippi
Neb
raska
Kentucky
New
Mexico
COLLIER COUNTY
ALA
CHUA COUNTY
Louisiana
Untreated Cavities in Third Graders (%)
Data from National Oral Health Surveillance System http://www.cdc.gov/oralhealthdata/ and county oral health surveillance systems
Summary
• Florida’s children covered by Medicaid/CHIP have among the nation’s lowest dental utilization rates
• Rate of emergency department use for dental problems by Florida’s children continues to climb
• Based on statewide survey, Florida’s 3rd graders have relatively low prevalence of caries experience but relatively high prevalence of untreated cavities
• Surveillance in Alachua and Collier Counties (participation rates >90%) suggest they are either outliers or prevalence of caries was underestimated in state survey (participation rate 41%)
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Challenges
• FL has very large child population and high levels of poverty
• Among the nation’s lowest Medicaid dental reimbursement and dentist participation rates
• Among the nation’s lowest per‐capita funding for education and public health
Solutions?
• That’s why we’re here!
