Monday, November 24, 2014

Responding to Urgent Community Needs

As we prepare to celebrate Thanksgiving with family and friends, we want to recognize some community organizations. Over the year, the DentaQuest Foundation reserves grant funds to respond to urgent equipment and capacity needs at care and prevention organizations. Without this assistance, many of these vital community health organizations might have had to limit what are often invaluable services for targeted communities. Here are some examples:
  • Little City Foundation (Chicago), operating under the umbrella of the Center for Health and Wellness, provides specialized medical and oral health care for children and adults living with autism, intellectual, or developmental disabilities. It is the only on-site facility of its kind in Illinois. Little City Foundation has developed expertise in a desensitization process has been helpful in preparing clients before they receive oral health services. The agency’s dental hygienist has been demonstrating this model to peer agencies, school districts, individuals and families in the greater Chicago metropolitan area, helping more than 350 children a year. A Community Response Fund grant has enabled a part-time hygienist to extend this training to more caregivers, school districts and peer agencies.
  • Bering Omega Community Service’s Oral Health Clinic (Texas) tends to the wellbeing of people affected by HIV/AIDS in Southeastern Texas. In 2013, the clinic cared for 2,500+ indigent and uninsured individuals. A grant from the Community Response Fund assisted with general operating costs so the clinic could continue to nurture and support patients with HIV/AIDS.
  • As a teaching hospital, St. Vincent Charity Medical Center (Cleveland) is providing a new generation of healthcare providers with an excellent medical education and a passion for meeting the healthcare needs of their communities. A Community Response Fund grant supported a residency program for six young dentists, providing exposure to all phases of general dentistry, including anesthesia, internal medicine, general surgery, and emergency service. The Residence program provides comprehensive dental services to a diverse and low-income population. 
  • Elko Family Dental Center (Nevada Health Centers) is the largest resource for primary care for uninsured, underinsured, and geographically isolated people in Nevada —its rural and frontier clinics are often the only places where people can get healthcare without having to travel hundreds of miles. The Centers accept Medicaid and offer a sliding fee scale based on federal poverty levels. The Elko dental office has two dentists and previously only one functioning dental chair. A Community Response Fund grant added a second chair and helped the clinic reduce wait times and serve many more patients.
  • Saban Community Clinic’s Comprehensive Dental Program (Los Angeles) provides oral health services to children and adults at two sites in Los Angeles. Many of Saban’s patients recently became eligible for the Denti-Cal program which added dental coverage for adults effective May, 2014. Anticipating a growing demand for dental services, Saban requested funding from the Community Response Fund to replace aging equipment.
  • The Caring Hands Dental Clinic is recognized as a Minnesota Critical Access Dental Provider and a National Health Service Corp site. Its Mobile Outreach Hygiene Clinics provide x-rays, cleanings, exams, and fluoride treatments to residents of area nursing homes. Providing dental services where the patients live eliminates the stress and possible complications of transportation and has enabled the clinic to reach patients at additional nursing homes. A Community Response Fund grant offset the cost of supplies and travel.
  • When the Roxbury Comprehensive Community Health Center (Boston) closed in 2013, thousands of patients might have been left without dental care options. Nearby Whittier Street Health Center (Boston) stepped in and has been transitioning RoxComp patients into their departments. The volume of newcomers to Whittier’s dental program resulted in backlogs with patients waiting for months to get a dental appointment. A Community Response Fund grant helped Whittier Street Health Center add dental chairs, expanding capacity, improving operational efficiencies, and increasing access to timely and cost-effective care in a high-need community. 

The oral health community is made richer and stronger because of these community organizations and their efforts. While on the path toward larger-scale systems change with Oral Health 2020, the DentaQuest Foundation will continue to provide essential resources to address urgent community needs of underserved populations.

Friday, November 21, 2014

Friday Dental Download: November 21, 2014

This week we discuss that while Americans are gaining dental coverage, they still aren’t getting treated, we learn that tooth decay is linked to risk of kidney disease, and we discover a toothbrush that makes brushing your teeth fun! Don’t forget to check out our Movember blog post to learn more about the relationship between men’s health and dental health, and our new blog series, Why it Matters to Me. Join the conversation on Twitter using #FridayDentalDL.

1. Financial hurdles remain for dental care: Americans are gaining dental coverage through the Affordable Care Act, but according to the dental community, the health care law isn't doing enough to Medicaid to improve reimbursement rates for the care. According to the American Dental Association, approximately 8.7 million children – and about 800,000 adults – could gain extensive dental coverage through the ACA by 2018. A barrier to access dental care is the lack of private dental offices that accept Medicaid or limit the number of Medicaid patients.

2. Cardiologists have knowledge gaps about perio disease: A new study in the Journal of Dental Hygiene looked at cardiologists' knowledge of the relationship between periodontal disease (tooth decay) and heart disease and found that many were unclear about the cause of periodontal disease. Over the past several years, new evidence has shown links between tooth decay and diabetes, adverse pregnancy outcomes, and heart disease. The majority of physicians who participated in the study agreed it is important for cardiologists and periodontists to work together to educate their patients about oral systemic disease risks.

3. An entrepreneur’s vision for dental hygiene: Tooth brushing as an immersive experience: Alex Frommeyer, CEO of Beam Technologies, plans to shake up the world of tooth brushing with the Beam Brush, a platform connecting consumers with their toothbrush, dental goods and services. The electric toothbrush tracks brushing activity through its partnered iOS and Android app. The app collects behavioral data, such as brushing time and movements. It also keeps score for families to compare and share. The updated brush, scheduled to come out December 1, 2014, becomes a remote control for several games, including a horizontal scrolling game with obstacles similar to Mario. This feature allows users to play a game on their app with their tooth brush – engaging them in a mission to brush their teeth for 2 minutes without getting bored.

4. Periodontal disease linked to increased risk of kidney disease: In a study of African-Americans with normal kidney function, those with severe periodontal disease developed chronic kidney disease at four times the rate of those without severe periodontal disease, according to a presentation at the recent American Society of Nephrology meeting in Philadelphia. Researcher Dr. Vanessa Grubbs noted that because periodontal disease is common and can be prevented and treated, targeting it may be an important path towards reducing existing racial and ethnic disparities in chronic and end-stage kidney disease.

Tuesday, November 18, 2014

DentaQuest at AHIP Health Insurance Exchanges Forum in Phoenix

We know that consumers in all age groups want ancillary health benefits such as dental and vision – benefits they can use. In fact, more than 1.1 million consumers bought a dental plan on the federal Marketplace during last year’s open enrollment period.

Health care reform and insurance marketplaces have changed how our industry operates. But with years of experience on marketplaces – since long before the Affordable Care Act was enacted – DentaQuest was prepared. We’ve developed strategies to turn our industry’s changes into growth opportunities for local and regional health plans nationwide.

With more than 20 million members and networks in 28 states, DentaQuest is one of the nation’s largest dental benefit managers and a strategic business partner to health plans nationwide. We will be at the AHIP Health Insurance Exchanges forum in Phoenix, Arizona, this week from November 18-19. Stop by Table 18 in Salon E and let us show you how to make dental and vision products a profitable part of your exchange offerings (and don’t forget to enter for a chance to win a Martian Victory Smart Watch).

Monday, November 17, 2014

Why This Matters to Me Part 3: Reducing Costs by Controlling Periodontal Disease

By Steve Pollock, Chief Operating Officer, DentaQuest

Chronic diseases are among the most prevalent and costly of health problems in the United States. According to the Centers for Disease Control and Prevention, about half of all adults—117 million people—have one or more chronic health conditions and the combined cost of heart disease and stroke  in 2010 was estimated to be $315.4 billion. The American Diabetes Association estimates that 25.8 million Americans are diagnosed with diabetes, and another 7 million are undiagnosed. This resulted in $245B in spending on diabetes patients in 2012 alone. Clearly, uncontrolled chronic disease puts a significant strain on how healthcare dollars are spent.

As health plans try to rein in costs, managing chronic disease has become a major focus.  It’s also why including dental benefits in your health plan offerings can have a significant impact.

What many medical professionals don’t realize is that dental professionals play a significant role in providing the care and tools that can and do help to control chronic disease. There have been a number of studies that demonstrate that when patients with periodontal disease, an extreme form of dental disease, get treated, we see significant drops in the treatment costs for other chronic conditions. The studies also indicate that patients who receive treatment for their periodontal disease are better able to control their other chronic conditions and therefore, have fewer hospital admissions. For example:

  • According to a study from Blue Cross Blue Shield, the average cost of treating diabetes was $1800 less when getting periodontal treatments over 3 years.
  • Columbia University, which looked at claims data from Aetna, found decreased costs of 9% for diabetes patients, 16% for coronary artery disease patients, and 11% for cerebrovascular disease patients who were undergoing periodontal treatments.

To address the relationship between chronic disease and oral health, DentaQuest developed the One Less Worry program to help members control their diabetes through oral care maintenance. Its goals are to:

  • Increase dental access
  • Reduce the incidence of periodontal disease
  • Promote healthy lifestyles for members
  • Provide education to the medical and dental communities to raise awareness of the connection between oral disease and diabetes
  • Integrate medical data with dental data to deliver services and maximize outcomes

We reach our members in two ways. First, we send brochures and postcards directly to members with diabetes. The brochure highlights steps they can take to live a healthier lifestyle, which includes brushing, flossing, and making an appointment to see a dentist. Six months after the initial mailing, we analyze claims data to determine which members have not been to the dentist since they received the brochure. Those members are then sent a postcard reinforcing the importance of scheduling a dental appointment. Twice per year, we compile a report that measures the success of the mailings based on the number of members seeing a dentist before and after the mailing. 

Second, we work with our insurance partners’ case managers, physicians, and community based organizations to encourage them to recommend their diabetic patients see a dentist. These two tactics together will hopefully lead to better patient outcomes.

As the margins continue to compress and insurers look for new ways to manage costs, the plans that think outside the box about unique and effective ways to manage chronic disease will be well positioned for future growth.

Friday, November 14, 2014

Friday Dental Download: November 14, 2014

This week we learn how Colorado is leading the way in oral health, discover how mucus in the mouth fights cavities, and discuss why millions of kids on Medicaid are missing free, preventive exams. Don’t forget to check out our Movember blog post to learn more about the relationship between men’s health and dental health, and our new blog series, Why it Matters to Me. Join the conversation on Twitter using #FridayDentalDL.

1. Colorado leads the way in oral health: In May 2013, Gov. John Hickenlooper called oral health "a winnable battle for Colorado" when he signed into law a bipartisan bill that provides dental benefits for low income adults through the state's Medicaid program, beginning in 2014. Until this July, Colorado's Medicaid adult dental benefits were limited to emergency services only, stopping residents from receiving the preventive care they needed to keep their mouths healthy. Now, Medicaid covers preventive care such as cleanings, minor fillings, and x-rays as well as comprehensive services including root canals, crowns, partial dentures, periodontal scaling and root planning. We’re proud of the work in Colorado and excited that residents are on their way to better oral health.

2. How Mucus In Mouth Fight Cavities, Harvard University Study: A recent study released by Harvard University researchers found that salivary mucins, key components of mucus, actively protect teeth from bacteria in the mouth that is a significant contributor to tooth decay. The bacteria attach to teeth and cause them to dissolve, which is a direct cause of tooth decay. The salivary mucins prohibit those bacteria from attaching to teeth.

3. Report: Millions of kids on Medicaid miss free, preventive exams: The Department of Health and Human Services’ Office of Inspector General (OIG) reported Thursday that missions of low-income children are missing the free preventive exams and screenings guaranteed by Medicaid. According to the report, 63 percent of children on Medicaid received at least one medical screening in 2013, up from 56 percent in 2006, but still far below the department’s 80 percent goal. According to the National Academy for State Health Policy, data collection is an issue for some states, but it doesn’t explain most of the low rates. In addition to the shortage of doctors participating in Medicaid, parents often face transportation and language barriers getting children in for the exams

4. DentaQuest Pediatric, Adult and Family Dental Plans Available on health Insurance Marketplaces: DentaQuest has received certification as a Qualified Health Plan to offer individual and small group stand-alone dental plans on the 2015 Federal Marketplace in the states of Arizona, Florida, Georgia, Pennsylvania, Texas, Virginia, and on Maryland Health Connection, the State Marketplace in Maryland. The Open Enrollment period for 2015 coverage begins Saturday, November 15, 2014 and runs through February 15, 2015. For more information about your options click here.

Thursday, November 13, 2014

DentaQuest Pediatric, Adult and Family Dental Plans Available on Health Insurance Marketplaces

By: Steve Pollock, DentaQuest Chief Operating Officer

DentaQuest has received certification as a Qualified Health Plan to offer individual and small group stand-alone dental plans on the 2015 Federal Marketplace in the states of Arizona, Florida, Georgia, Pennsylvania, Texas, Virginia, and on Maryland Health Connection, the State Marketplace in Maryland.

DentaQuest’s plans offer a high-quality and affordable dental insurance option that fulfills the pediatric dental essential health benefit (EHB) for children. Adult benefit plan designs are also available and range from basic coverage to a more comprehensive plan.

The Open Enrollment period for 2015 coverage begins Saturday, November 15, 2014 and runs through February 15, 2015.

Individuals and families who currently have a dental plan with DentaQuest that they purchased through the health insurance marketplace in 2014 will be renewed in their plan automatically for 2015. They will see no interruption in their benefits and will not have to take any action unless they want to make a change.

Having dental coverage is important for good overall health. Cavities and gum disease are nearly 100 preventable. The Affordable Care Act made sure pediatric dental and vision services are essential benefits. It is important for children to get regular checkups and preventive treatments throughout their childhood and teen years. We look forward to helping families get affordable dental coverage to help their children stay in good health.

DentaQuest administers statewide Medicaid dental benefit programs in Florida, Maryland and Virginia, and the statewide Medicaid and CHIP program in Texas. DentaQuest also administers dental benefits on behalf of several health plans in Florida, Maryland, Pennsylvania, Georgia, Arizona and Texas.

Detailed information about DentaQuest’s individual and family dental insurance plans on the Health Insurance Marketplaces can be found at:

Friday, November 7, 2014

Friday Dental Download: November 7, 2014

This week we discuss the link between diabetes and dental care, learn that financial issues are the main reason for delayed oral care, and discover why Americans need to pay more attention to preventive care. Don’t forget to check out our Movember blog post to learn more about the relationship between men’s health and dental health, and our new blog series, Why it Matters to Me. Join the conversation on Twitter using #FridayDentalDL.

1. ADA report: Financial issues are main reason for delayed dental care: Financial factors are often the main reason people delay getting needed dental care, according to a new report for the ADA Health Policy Institute. Furthermore, access to dental care will become more difficult as millions of children and adults gain dental coverage under the Affordable Care Act (ACA). The report also found that the percentage of people who needed but could not access dental care fell from 18.2 percent in 2004 to 14.6 percent in 2012.

2. Dental x-rays could be first step in osteoporosis screening: A new study shows panoramic dental x-rays can be used to help identify low skeletal bone mineral density (BMD) in postmenopausal women, which means that screening for spinal osteoporosis could begin in the dentist's office. The study included 316 postmenopausal women who had no symptoms of osteoporosis, however 159 had no history of hysterectomy, oophorectomy or estrogen use, the remaining 157 had one or more of these histories. The study found that dental x-rays were just as effective as questionnaires in identifying those women. Dental x-rays, looking at the shape and width of the jaw, were 87 percent effective in identifying women with spinal osteoporosis.

3. Cigna Dental Insurance Study: Americans Need to Pay More Attention to Preventive Dental Care: According to a recent survey of U.S. consumers, more than one-fourth of adults with dental insurance don’t take full advantage of their preventive care benefits.  Most dental plans cover preventive checkups every six months, yet the study found that people are avoiding getting any care during the year because of a fear of the cost of fear of the dentist. Others say they don’t feel the need to get checked more frequently than once per year because their teeth don’t hurt. However, absence of pain does not mean absence of problems. For more information about why preventive dental visits matter, click here.

4. Dentist Involvement Recommended for Diabetes Care: Dentists are in a unique position to identify patients with diabetes as well as patients already diagnosed  with diabetes who are at increased risk for complications. Researchers found that older people are more likely to visit a dentist than a primary care physician. With the projected rise in chronic diseases, including diabetes, and the growing shortage of primary care physicians, it is important for dental and medical health care providers to work together to tackle this public health issue. For more about the link between oral health and diabetes click here.

5. DentaQuest Foundation Grant Supports Oral health American’s Increased Focus on Older Adult Health and Wellness: Every day 10,000 people retire and only 9.8 percent do so with a dental benefit.  To reshape systems that will impact lifelong oral health and stem the growing crisis facing older Americans when it comes to paying for oral healthcare, the DentaQuest Foundation has awarded Oral Health America (OHA) with a $299,450 grant. This grant will be used to support new initiatives within the Wisdom Tooth Project (WTP), OHA's program that strives to improve access and utilization of care, health literacy and policies that promote oral health equity for those most vulnerable.

Thursday, November 6, 2014

Men’s Health Movember 2014

Have you noticed the number of new mustaches and beards emerging during November?  It may be men supporting the Movember movement.

Men across the country are taking action by signing up and shaving down their face on November 1 and growing a mustache for the month, and it’s all in support of men’s health.

In the spirit of Movember, DentaQuest is bringing attention to ways men can support their own health by cultivating a healthy mouth.

Good oral hygiene and regular dental visits are important for everyone.  Surveys show that men often neglect their teeth and gums for years and are less likely than women to seek preventive care when they should. In fact, one of the most common factors associated with infrequent dental checkups is just being a guy.

Here are 6 ways men’s mouths can stay out of trouble this month:

1. Regular dental checkups
According to research published in the Journal of Periodontology, women are almost twice as likely as men to have had a regular dental checkup in the past year.  Did you know that dental diseases (cavities and gum disease) are preventable?

2. Take care of your teeth and gums every day
According to the Academy of General Dentistry and the American Dental Association, the average man is less likely to brush his teeth twice a day (49% compared with 56.8% of women), and more likely to develop periodontal (gum) disease.

New research is showing that not taking care of gum disease may put you at greater risk for other chronic diseases like heart disease, diabetes and rheumatoid arthritis. Gum disease can be managed with daily brushing and flossing, and routine visits to a dental health professional. Men who develop gum disease may be advised to consult with a periodontist, the dentist specially trained in the prevention and treatment of periodontal disease for a treatment plan to manage the disease.

3. Monitor you cardiovascular health
Medications (for heart disease, blood pressure or antidepressants) can slow the flow of saliva, leading to dry mouth.  Saliva is important; it helps clean bacteria and food particles from your teeth. Having a dry mouth increases your risk for cavities and gum disease. And, gum disease puts you at greater risk for complications of other diseases (see #2 above). Your dentist can help you with options for dry mouth.

4. Eliminate tobacco use
If you smoke or chew tobacco, you have a greater risk for periodontal disease and oral cancer (electronic cigarette use is just as dangerous for the mouth as regular cigarettes). Men are affected twice as often as women. The most frequent sites for oral cancer are the tongue, the floor of the mouth and soft palate (‘roof’ of the mouth).

You want to catch and treat any and all cancerous spots in the early stages. Today, dentists check your mouth for oral cancers at every dental visit.  If you do use tobacco, watch for changes in your mouth and call your dentist or doctor if you see something that is out of the ordinary. Be sure to see your dentist regularly for oral cancer screenings.

5. Be cautious when participating in athletics

Serious athletes and weekend warriors who play contact sports like football, soccer and basketball have a greater potential for trauma to the mouth and teeth. If you ride bicycles or motorcycles, wear a helmet. Athletes AND weekend warriors should also be sure to use a mouth guard to protect their teeth from unnecessary mouth injuries. Your dentist can help you pick the best mouth guard for your lifestyle.

6. And, do this every day for a healthy smile:

  • Brush twice daily (for two minutes each time) using a soft-bristled toothbrush and fluoride toothpaste. Reach every surface of the tooth, even the ones way in the back, and gently clean between the teeth and the gums.
  • When the bristles on your brush are frayed, buy a new one (every 3 months).
  • Floss daily, it is much more important than you think.
  • Visit your dentist regularly.
  • Avoid opening things with your teeth.

This is all worth the effort. Good oral health has been linked with longevity, and life is better with teeth. Happy Movember!

Image via

Monday, November 3, 2014

Improving Oral Health – Day by Day, Month by Month, Year by Year

As a U.S. leader in oral health, DentaQuest is driven by a mission to improve the oral health of all.

During our third annual Mission Month, teams from DentaQuest offices across the country had the opportunity to give back in the communities where we live and work. From processing food for meals at a food bank to volunteering at a free dental clinic, we were honored to support local organizations that are making a difference in their communities. We left impressed with what you accomplish every day and humbled by the stories we heard from so many of you.

From Maryland to California, DentaQuest employees blanketed the country in goodwill:

In Maryland and Virginia, we painted the lobby at Mary’s Place, a community health center.
In Florida, we cleaned parks and community common spaces in Miami Dade.
In Texas, we sorted food for over 15,636 meals at the Capital Area Food Bank.
In Wisconsin, we worked with the Boys and Girls Clubs of Milwaukee.
In South Carolina, our team served food and gave out health kits in the Ronald McDonald Room at Palmetto Memorial Hospital.
In Colorado, we applied our dental skills at the Mission of Mercy free care dental clinic in Henderson.
In Massachusetts, we helped a city school create an outdoor auditorium space able to accommodate all its students.
In Tennessee, we supported the Nashville AIDS walk.
In California, we assembled thousands of health kits for community members. 

Everywhere we went, we spoke to children, adults and families about the importance of preventive dental health care. Dental Disease is the most common chronic disease among children, and it is nearly 100 percent preventable. Every year, dental problems are the reason for more than 51 million hours of school absences. Children suffering from mouth pain are not able do their best in school. And it is not just children. Adults lose close to 164 million work hours because of dental problems.

Those of us who work at DentaQuest are working to help achieve a nation free of dental disease: where no child suffers from the pain of tooth decay, where adults keep all their teeth for their entire lives, and where every person has access to quality dental care.

We are proud of the work we did this past month to improve lives. Our work does not stop after one month. Improving the oral health of all is what we do all year long!


DentaQuest Joins 122 State and National Organizations Urging Extension of CHIP Funding beyond FY 2015

By Steve Pollock, Chief Operating Officer

Since 1997, the Children’s Health Insurance Program (CHIP) has helped children of low income families get access to high quality health care – and since 2009, CHIP has included dental care.

Today, CHIP covers more than 8 million U.S. children in low income families whose income exceeds Medicaid eligibility levels. CHIP also offers financial protection from high out-of-pocket healthcare expenses.

CHIP is a public policy success story with bipartisan support from state and federal policy makers.

The program helps alleviate one of the biggest obstacles to getting preventive dental care – COST. Research shows that uninsured children are far less likely to receive medical/dental care than peers who have health insurance.1 Nearly half of all parents in a 2013 survey said that over the previous 12 months they or a family member had delayed seeing a dentist because they couldn’t afford the expected out-of-pocket costs.2  In a 2011 survey, 63 percent of parents said affordability was a key motivating factor for enrolling their children in the CHIP or Medicaid programs.3   Today, children enrolled in Medicaid/CHIP have much higher rates of access to and use of oral health services compared to children with no coverage.4

By providing affordable coverage to 8 million low-income children, including 52 percent of Hispanic children and 56 percent of African American children nationwide, Medicaid and CHIP address racial, ethnic and socioeconomic inequality in access to health care. One state found that disparities in access to care and unmet need among children were nearly eliminated during the year following enrollment in CHIP.5

Our mission at DentaQuest is to improve the oral health of all.  Dental disease is the most common chronic illness among children. CHIP has made great strides in addressing this silent epidemic. DentaQuest is honored to be a partner with many state CHIP programs.

Today, the CHIP program is in jeopardy — despite 17 years of success.

The Affordable Care Act only assures funding for CHIP through FY 2015. It is now up to Congress to allocate funding for the program to continue. If Congress does not act, the CHIP program will dissolve and millions of children will transition to subsidized coverage on state-based or federally – facilitated Marketplaces.

Although Marketplace coverage may sound like an acceptable alternative to CHIP, it is not, especially when it comes to oral health.

Because of an unintentional loophole in the ACA, dental coverage for children (and adults) is optional through the Marketplaces. Additionally, families purchasing dental coverage through a Marketplace will face higher out-of-pocket costs and will likely find that the subsidies for which they are eligible do not apply to the dental premium.  That can be a significant cost. Today, total family out-of-pocket costs for CHIP – including premiums — are limited to 5 percent of family income. 6

Our fear is that parents may not enroll their children and millions of children will lose access to critical oral health services.

For all these reasons, DentaQuest supports an extension of CHIP funding beyond FY 2015. We encourage our lawmakers to act now and approve an extension of CHIP funding before the end of the year.

Securing CHIP’s future will help ensure that we do not lose ground on our goal of improving the oral health of all.

1 “A 50-state examination of CHIP spending and enrollment,” The Pew Charitable Trusts , 2014

2 Dental care survey sponsored by the Children’s Dental Health Project and conducted by Wakefield Research, between September 26 and October 4, 2013. For a summary of the survey results, see:

3 “Informing CHIP and Medicaid Outreach and Education,” Centers for Medicare and Medicaid Services, November 2011, p. 13,

4 “The Effects of the State Childrens Health Insurance Program on Access to Dental Care and Use of Dental Services,” Health Services Research, August 2007

5 “The Impact of the Children’s Health Insurance Program (CHIP): What Does the Research Tell Us?” Kaiser Family Foundation, 2014

6 “The Impact of the Children’s Health Insurance Program (CHIP): What Does the Research Tell Us?” Kaiser Family Foundation, 2014