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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Preventive Dental Visit: Pregnancy.

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Strategy. Medicaid Reforms. (13.1)

Approach. Provide comprehensive dental coverage for Medicaid-enrolled pregnant women during pregnancy and postpartum

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Overview. Research indicates that expanded Medicaid dental coverage for expectant parents was linked to better oral health in adulthood.[1] Studies demonstrate the importance of Medicaid dental coverage for expectant parents.[2] The Medicaid dental benefit increases access to and utilization of oral health care among women enrolled in Medicaid and reduces gaps between Medicaid and privately insured groups.[3] Findings highlight the need for extending Medicaid dental care coverage from pregnancy to the postpartum period, which is currently limited, posing a major public health issue for new mothers to continue oral health care.[4,5,6,7]

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of states that provide comprehensive dental coverage for pregnant women enrolled in Medicaid. (Measures level of adoption of expanded Medicaid coverage policy)
  • Number of Medicaid-enrolled pregnant women who receive education about their dental coverage and benefits. (Measures reach of Medicaid benefit promotion efforts)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of Medicaid-enrolled pregnant women who receive guidance on how to navigate dental benefits and access care. (Measures level of care coordination for Medicaid-enrolled pregnant women seeking dental care)
  • Percent of dental services provided to Medicaid-enrolled pregnant women that adhere to practice guidelines. (Measures level of quality of care delivered to pregnant women as a result of Medicaid dental expansion)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of partnerships established between Medicaid agencies and perinatal programs to promote dental coverage. (Measures level cross-sector collaboration in perinatal dental programming)
  • Number of OB/GYN and prenatal care providers educated about Medicaid dental coverage for pregnant patients. (Measures level of perinatal dental care integration with Medicaid-sponsored medical care)

OUTCOME MEASURES:

  • Number of Medicaid-enrolled pregnant women referred by prenatal providers who receive a dental visit. (Measures effectiveness of integrated referrals between medical and dental providers)
  • Number of children of mothers with Medicaid dental coverage who receive preventive oral health services. (Measures impact of Medicaid dental expansion across generations)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of Medicaid dental coverage outreach and enrollment efforts tailored to pregnant women facing challenges to healthcare access. (Measures benefit promotion and outreach)
  • Percent of Medicaid-enrolled pregnant women from various communities who utilize dental coverage. (Measures utilization of dental services post-Medicaid dental expansion)

OUTCOME MEASURES:

  • Percent of pregnant women who achieve oral health stability during pregnancy and postpartum. (Measures long-term oral health outcomes for various populations)
  • Percent reduction in adverse birth outcomes and pregnancy complications among Medicaid-enrolled women with improved oral health care access. (Measures impact of Medicaid dental expansion on perinatal health outcomes)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Lipton BJ, Wherry LR, Miller S, Kenney GM, Decker S. 2016. Previous Medicaid expansion may have had lasting positive effects on oral health of non-Hispanic black children. Health Affiliate. 35(12):2249-2258. doi: 10.1377/hlthaff.2016.0865. PMID: 27920313.

2 Lee H, Marsteller JA, Wenzel J. 2022. Dental care utilization during pregnancy by Medicaid dental coverage in 26 states: Pregnancy risk assessment monitoring system 2014–2015. Journal of Public Health Dentistry 82(1):61–71.

3 Naavaal S, Harless DW. 2022. Comprehensive pregnancy dental benefits improved dental coverage and increased dental care utilization among Medicaid-enrolled expectant parents in Virginia. Frontiers in Oral Health 3.

4 Puett S, Tellez M, Byrd G, Weintraub JA, Ciszek B, Phillips C, Boggess K, Quinonez R. 2022. Retrospective study of prenatal and postnatal gaps in oral health care utilization: Medicaid policy implications. Maternal and Child Health Journal 26(3):642–648. doi: 10.1007/s10995-021-03343-9. Epub 2022 Jan 8. PMID: 34997435.

5 Moss ME, Grodner A, Dasanayake AP, Beasley CM. 2021. County-level correlates of dental service utilization for low income expectant parents. Ecologic study of the North Carolina Medicaid for expectant parents (MPW) program. BMC Health Service Research 21(1):61.

6 Association of State and Territorial Dental Directors. 2020. Perinatal Oral Health Policy Statement. Reno, NV: Association of State and Territorial Dental Directors.

7 National Maternal and Child Oral Health Policy Center. 2012. Improving the Oral Health of Pregnant Women and Young Children: Opportunities for Policymakers. Washington, DC: National Maternal and Child Oral Health Policy Center.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.