5.4 Use of Public Funding

Medicaid and the Children’s Health Insurance Program

Given the FRPM program eligibility requirements of ODH-funded sealant programs, a large proportion of children at schools with sealant programs are expected to be Medicaid beneficiaries. ODH’s Make Your Smile Count! A Survey of the Oral Health of Ohio Schoolchildren, 2004–2005 estimated that 56 percent of children at schools with sealant programs were Medicaid beneficiaries,8 and reports by ODH-funded sealant programs indicate 40 percent in 2007.

ODH uses federal Maternal and Child Health (MCH) Block Grant funds to fund sealant program grants to local agencies, most of which are local health departments. To ensure that as many children at higher risk for dental caries as possible receive sealants, ODH relies on the programs it funds to engage in good faith efforts to use their grant funds primarily for children who do not have a third-party source of payment.

Medicaid is the most common third-party payer for oral health care for children, particularly those at schools with large proportions of children at higher risk. Per federal law, programs that receive MCH Block Grant funds can be reimbursed for Medicaid-covered services rendered to Medicaid beneficiaries, even if those services are provided free of charge to the general public.9

Therefore, ODH-funded dental sealant programs must identify the children they serve who are Medicaid beneficiaries and must collect the reimbursement due to the program. In addition, programs should provide parents of children potentially eligible for Medicaid with enrollment information. Given that sealant programs may be unlikely to have direct contact with parents, this may amount to sending home written materials.

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