ADV-AD: Any Dental Visit - Adult (GC-20)
Notes on Methodology
- The annual reported rate captures activity during the previous calendar year.
- This is a DVHA custom measure that is based on the specifications for the Healthcare Effectiveness & Data Information Set (HEDIS) child dental visit administrative measure.
- The solid blue line in the graph above represents all adults ages 21+
Story Behind the Curve
This measure looks at the percentage of Medicaid beneficiaries ages 21 and older who had any dental visit during the past year. It is a DVHA custom measure that follows the HEDIS any dental visit specifications for children. Regular visits to the dentist provide access to cleaning, early diagnosis and treatment, as well as education on how to prevent problems.
The Agency of Human Services (AHS) made the following changes to the Medicaid adult dental benefit effective January 1, 2020.
• Increasing the annual maximum dollar limit on adult dental services from $510 to $1,000.
• Allowing up to two visits for preventive services per calendar year that do not count towards the $1000 annual maximum dollar limit.
• Removing copayments from preventive dental services.
The changes are intended to expand adult Medicaid beneficiaries’ access to dental care and encourage the utilization of preventive dental care. These changes apply to Medicaid beneficiaries age 21 and older, who are not pregnant or in the postpartum period.
AHS is also removing the prior authorization requirements for periodic prophylaxis to allow more than two cleanings per year without prior authorization when medically necessary. This prior authorization change applies to all Medicaid beneficiaries.
Pandemic-related eligibility increases resulted in a larger denominator for this measure in 2021 (for measurement year 2020). This, combined with reduced dental office availability, resulted in the decline in % of adults with a dental visit. The changes to the adult dental benefit along with dental offices being open more consistently in 2021 may have had a positive impact, as evidenced by the most recent data point in the graph above. Although the demoniminator (adult Medicaid members aged 21+) continued to increase, a slightly higher percentage of members had a dental visit.
Last updated: July 2022
- Medicaid beneficiaries
- Vermont Department of Health - Office of Oral Health