The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit requires that state Medicaid agencies facilitate the provision of comprehensive health care services – medical, dental, hearing, and vision – for children enrolled in Medicaid up to the age of 21. In September 2024, the Centers for Medicare and Medicaid Services (CMS) issued a State Health Official letter reminding states that EPSDT requires them to “develop or adopt a dental periodicity schedule in consultation with recognized dental organizations in child health.” CMS had previously noted in a 2018 Informational Bulletin that “the periodicity schedule should be treated as a ‘floor’ for coverage of dental services,” and “states should have a mechanism in place to cover medically necessary dental services that exceed the periodicity schedule.” 

The Research & Policy Center recently attempted to locate each state’s dental periodicity schedule as an update to prior work in this area by AAPD and others. As of October 2024, 9 states have yet to adopt or develop a dental-specific periodicity schedule to be in compliance with this EPSDT requirement. 

  • AAPD: States that have adopted AAPD’s recommended dental periodicity schedule. Common language in the Medicaid materials that indicated adoption includes “accepts,” “follows,” “recommends,” “uses,” etc. (20 states)

  • State-Specific: States that have developed their own dental periodicity schedule. This includes states that indicated their periodicity was “based on” or “adapted from” the AAPD’s. (22 states)

  • Missing: States that have not yet adopted, developed, or made readily available a dental-specific periodicity schedule. This includes states that refer exclusively to the Bright Futures medical periodicity schedule, which reminds medical providers to screen for oral disease and refer to dentistry, but is not sufficient for the purposes of guiding comprehensive dental care. (9 states)

Please see the alphabetical listing of states below for more detailed information on the designation and location of dental periodicity schedules by state. If you see an error, please contact us at RPC@aapd.org. 

EPSDT is meant to ensure that state Medicaid agencies fulfill their obligation to:

  • Inform the families of Medicaid enrolled children of the services that are available to them;

  • Screen children for health care conditions that may require corrective action; and

  • Provide any health service that is medically necessary.

Detailed recommendations regarding the periodicity of dental services for children can be found in the AAPD's Best Practices on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance, and Oral Treatment for Children. This resource contains a schedule and accompanying text outlining the recommended content and periodicity of developmental assessments, clinical examinations, diagnostic tests (including radiographic assessments), counseling, preventive services and periodic re-evaluations. Additionally, the AAPD’s Recommended Dental Periodicity Schedule is publicly available online. The AAPD’s periodicity schedule is reviewed on a regular basis (at least every 5 years) by an expert group of pediatric dentist clinicians and researchers, and revised when deemed necessary. The most recent revision was for the addition of “transition to adult dental care,” recommended for those 12 years and older.

Periodicity schedules serve as invaluable resources for communicating to both enrolled members and participating providers about the services – at a minimum – for which members are eligible to receive and providers can be paid. While AAPD is pleased that many states have found AAPD’s recommended dental periodicity schedule worthy of adoption, we commend all states that have identified a dental periodicity schedule, including those that have a state-specific dental periodicity schedule. The state-specific dental periodicity schedules are typically extremely similar to the AAPD’s schedule, sometimes varying only in the title of the resource to include the name of the state. 

The following are additional considerations and recommendations for state Medicaid agencies and their contractors based on this recent assessment of dental periodicity schedules:

  • The dental periodicity schedule should be available from the state Medicaid agency (directly) and from any third-party dental benefits administrators or managed care entities.

  • The dental periodicity schedule should be readily accessible in any and all logical chapters/sections of Medicaid provider manuals and other materials. For instance, it is possible that some dental providers may not be aware of the need to access the EPSDT chapter/section for this information, so it is important that the information is also available in the dental chapter/section, as well as the web pages for consumers/enrolled members.

  • States should not feel limited by the AAPD periodicity schedule. If additional services would be beneficial for children in the state on a population level, such services should be incorporated into the dental periodicity schedule. (Please see this example from South Dakota where “referral to a primary care physician” is included as an additional service for the dental provider to consider.)

  • Some states have created a consumer-friendly version of the dental periodicity schedule and made it available in multiple languages. (Please see this example from New Jersey.)

Dental Periodicity Schedule Status (October 2024)

Please note: We attempted to link to web pages that will be sustained, recognizing that Medicaid manuals are frequently edited and communications are often updated. As such, a few clicks may be necessary to get to the current resource, and page information is provided when possible to direct readers to the information of interest. 

If you recognize an error, please contact us at RPC@aapd.org.

The AAPD is eager to support states in their efforts to designate dental periodicity schedules that add clarity for enrolled children and their families, as well as dental providers and teams, on the baseline services that state Medicaid agencies must make available. Please contact us at RPC@aapd.org if we can be helpful in that regard.