DEPARTMENT OF HEALTH & HUMAN SERVICES 
Health Care Financing Administration 
Center for Medicaid and State Operations 
7500 Security Boulevard 
Baltimore, MD 21244-1850 
SMDL #01-010 
January 18, 2001 
Dear State Medicaid Director: 
Over the past few years, there have been numerous academic, professional, and government studies 
documenting the problems of access of low-income children to necessary dental services. All 
acknowledge that this is a complex problem, involving factors as diverse as outreach, reimbursement 
rates, workforce issues, and administrative complexities. 
Most recently, the Surgeon General of the United States issued the first-ever Surgeon Generals Report 
on Oral Health. (The executive summary of the report is available at: 
http://www.nidcr.nih.gov/sgr/sgrohweb/execsum.html.)  The Surgeon General said, Tooth decay is 
currently the single most common chronic childhood diseasefive times more common than asthma and 
seven times more common than hay fever. He went on to point out that this is not a minor issue, 
saying, Serious oral disorders may undermine self-image and self-esteem, discourage normal social 
interaction, and lead to chronic stress and depression as well as incurring great financial cost.  They also 
may interfere with vital functions such as breathing, eating swallowing, and speaking. The burden of 
disease restricts activities in school, work, and home, and often diminishes the quality of life. 
The Surgeon Generals report specifically notes that, Medicaid has not been able to fill the gap in 
providing dental care to poor children. Fewer than one in five Medicaid-covered children received a 
single dental visit in a recent year-long study period. 
As part of our ongoing responsibility for maintaining oversight of the program, this letter provides 
guidance on how the Health Care Financing Administration (HCFA) will assess State compliance with 
achieving childrens access to dental services under Medicaid. 
As you know, dental services are a mandatory Medicaid benefit for children. Section 
1902(a)(43) of the Social Security Act (Act) specifically requires that State Medicaid plans 
provide or arrange for such services and report to the Secretary on the number of children 
receiving dental services. In analyzing those State reports, the Office of the Inspector General 
observed in 1996 that only one in five children nationally had received any required preventive 
dental services in the year reviewed. Shortly thereafter, HCFA, in conjunction with the Health 
Resources and Services Administration and other public and private organizations, began an  effort to provide assistance to States in assessing and eliminating barriers to childrens access to 
Medicaid dental services. 
Page 2  State Medicaid Director 
At the same time, many States began to focus on oral health access problems and have adopted plans 
for eliminating barriers to childrens oral health services. In a 1999 survey of Medicaid dental activity, 
the American Public Human Services Association found that 42 of 44 responding States reported 
childrens dental access problems. The report described activities that several States have initiated to 
assess and overcome these problems. 
However, despite these recent State actions, the U.S. General Accounting Office (GAO) affirmed, in a 
report released September 2000, that overall utilization remains low.  Also, an earlier GAO study (April 
2000) determined that the availability of mandated coverage for children under Medicaid does not 
bridge the income gap to equalize the likelihood of visiting a dentist. 
Like you, we recognize a need to fulfill our responsibilities to assure equal access to oral health 
services. In reviewing HCFA-416 data that you have submitted for fiscal year1998, and in light of the 
reports noted above and other studies, it is apparent that a number of States are not meeting 
participation goals for pediatric dental services. These States must take further actions to improve 
access to these services for eligible children. We intend to provide technical assistance, information 
exchange, and ongoing analysis to help these States do so. 
As a result of widespread concern about childrens access to appropriate dental care, we also intend, 
through a program of State reviews, to increase our oversight activities and to assess State compliance 
with statutory requirements. To do so, we have established a two-tiered threshold for conducting 
reviews of State compliance with dental access requirements. The highest priority for conducting 
reviews will occur in States where the proportion of Medicaid-enrolled children who made a dental visit 
in the preceding year is 30 percent or less, based on the most recent data submitted by the State in its 
HCFA-416 reports.  As part of the assessment process, these States are likely to be visited by HCFA 
Regional Office staff. The second oversight threshold is reached if the proportion of enrolled children 
making an annual dental visit is above 30, but less than 50 percent; States falling into this category will 
be subject to review, but at a less intensive level. 
The thresholds that will lead to enhanced oversight and the intensity of reviews have been established at 
levels designed to assure that children eligible for Medicaid have comparable access to services as 
children in the general population. The most recent national data from the Medical Expenditure Panel 
Survey (MEPS) (which is derived from confirmed patient encounter data) indicates that 49 percent of 
children aged 18 and younger from families above 100 percent of the Federal Poverty Level (FPL) 
have visited the dentist at least once in a 12-month period. Fifty-six percent of children from families 
above 200 percent of the FPL have had an annual dental visit.  Data from the National Health 
Information Survey (NHIS)(which is based on parent interviews) suggests that annual visits among 
children above 200 percent of FPL may be as high as 73 percent.  Page 3  State Medicaid Director 
In conducting our reviews, we will collect information and assess State efforts in at least four areas to 
determine if States are in substantial compliance with Medicaid requirements: 
1. Outreach and Administrative Case Management for Children. Under section 1902(a)(43) of 
the Act, States are required to inform eligible beneficiaries of the availability of EPSDT services, and for 
providing or arranging for the provision of such services in all cases in which they are requested.  We 
will assess the adequacy of systems that: link together general health and dental providers; facilitate the 
referral of children to dental providers for required diagnostic, preventive and treatment services; assist 
children and their families in scheduling and attending dental appointments; and follow-up to assure that 
required services were rendered. 
These strategies can address access problems that are related to beneficiary and health provider lack of 
awareness and understanding of Medicaid dental benefits. Although these strategies will not remedy 
deficiencies in beneficiary access related to lack of participating providers, they play an important role in 
a comprehensive approach addressing access issues. States that lack such strategies would not be in 
compliance with 1902(a)(43). 
2. Adequacy of Medicaid Reimbursement Rates. The GAO, in its September 2000 report, notes 
that Medicaid payment rates often are well below dentists prevailing fees. While 40 States reported 
some rate increase since 1997, GAO notes that as expected, payment rates that are closer to dentists 
full charges appear to result in some improvement in service use. As you are aware, section 
1902(a)(30)(A) of the Act requires that payments for medical services be consistent with efficiency, 
economy, and the quality of care and are sufficient to enlist enough providers so that such care and 
services are available under the plan at least to the extent that such care and services are available to the 
general population in the geographic area.  (See also 42 CFR 447.204.)  Inadequate Medicaid non-
institutional provider rate structures may expose a State to serious litigation risk. A recent summary of 
litigation brought against Medicaid agencies to improve dental access found that of 22 cases in 18 
States, sixteen cases have been decided or settled and all have been resolved favorably for the plaintiffs. 
In addition, section 1902(a)(8) of the Act requires that States furnish medical assistance with 
reasonable promptness. If provider reimbursement is inadequate to enlist sufficient providers to meet 
beneficiary needs, then the State would also be out of compliance with this requirement. 
In general, HCFA believes that significant shortfalls in beneficiary receipt of dental services, together 
with evidence that Medicaid reimbursement rates that fall below the 50th percentile of providers fees in 
the marketplace, create a presumption of noncompliance with both these statutory requirements. Lack 
of access due to low rates is not consistent with making services available to the Medicaid population to 
the same extent as they are available to the general population, and would be an unreasonable restriction 
on the availability of medical assistance. A discussion of fee percentiles and determinants for 
appropriate fee-setting in the dental marketplace is found at TAB A.  Page 4  State Medicaid Director 
3. Increasing Provider Participation. We will assess the extent to which States are employing 
administrative strategies not directly related to provider reimbursement to enhance dental providers 
participation. Such strategies include, but are not limited to: simplification of provider enrollment 
procedures; rapid confirmation of childrens eligibility at the point of service; mirroring commercial 
insurance plans administrative processes to the extent possible; utilizing the American Dental 
Associations procedure codes and claims forms, and facilitating electronic claims submission; reducing 
prior authorization requirements and revising utilization controls to conform with those in the private 
sector; establishing a provider hot-line; and, using a dental advisory panel to provide guidance on your 
program and to field complaints from dental providers. 
In some instances, these strategies may reduce costs to dental providers, increase the purchasing power 

of Medicaid programs by assuring a steady volume of business and prompt payment to providers, and 

increase access to dental services while reducing the need for payment rate changes. Moreover, these 

strategies can integrate the volume of Medicaid business with the 

continuum of non-Medicaid care, so that providers will have an incentive to accept Medicaid patients. 

States that do not have such strategies may have more difficulty demonstrating sufficient beneficiary 

access to comply with the statutory requirements discussed above.

4. Claims Reporting and Processing. The HCFA-416 data are dependent upon data reported by 
providers.  These data may include provider claims for reimbursement submitted to the State or 
encounter data submitted by managed care organizations. We will assess the adequacy of the reporting 
systems States use to collect the dental data included on the HCFA-416. The new method for reporting 
dental service data on the HCFA-416 report should be useful in assessing your access issues. For 
States with large pediatric populations receiving dental care in managed care arrangements, it is 
especially important to assure that dental utilization data are obtained by the State from the managed 
care organizations. Dental claims data, in the format required by the HCFA-416, may not otherwise be 
provided routinely by these organizations. If you are not receiving adequate dental data from your 
managed care providers, your ability to report accurately on the HCFA-416 will be affected adversely. 
Action Plan for Improving Access to Oral Health Services. 
To prepare for our reviews and complement your own strategic planning efforts, each State falling under 
the criteria of either of our thresholds, based on either your 1998 or 1999 HCFA 416 report, must 
submit to HCFAs Regional Office a Plan of Action for improving childrens access to oral health 
services. As a preliminary measure, within 60 days from the date of this letter, States may 
provide additional data (such as revised HCFA 416 data, or data from scientifically conducted 
State access surveys) for HCFA consideration in determining the intensity of its review and 
that may be relevant in determining measures necessary to achieve compliance with statutory 
requirements. In the absence of such revised data, each Plan of Action should describe the activities  the State plans to undertake to assure, within three years, that adequate dental access exists. We 
expect to receive your Plan of Action within 120 
Page 5  State Medicaid Director 
days from the date of this letter.  The Plan should include:  (1) a discussion of your analysis of the 
access barriers in the State, and (2) an assessment of strategies you propose to implement to resolve 
identified access barriers in each (at a minimum) of the four areas outlined above. Several of the 
documents noted previously, and additional materials containing example of strategies being developed 
and implemented in the States to improve childrens access are listed in TAB B. We encourage you to 
share any innovative approaches and best practices you have developed in your State. 
In each Region, HCFA has identified an individual (listed in TAB C), to serve as the Regional Medicaid 
Dental Coordinator. That individual, working collaboratively with staff from the Health Resources and 
Services Administration (HRSA) Field Office, is available to provide you with technical assistance. 
Other assistance will be made available as part of the HCFA/HRSA Oral Health Initiative, which, as 
noted above, has been developing and providing assistance to States in collaboration with other Federal 
agencies, public and private organizations, and the dental professional community.  As part of that 
Initiative, HCFA and HRSA, in the near future, plan to announce Fiscal Year 2001 funding support for 
the conduct of State dental summits in up to 20 States. These meetings will provide the opportunity 
for State and local stakeholders to assist you, in a face-to-face forum, in developing State-specific 
strategies and implementation plans to resolve dental access barriers.  Recently, the National 
Governors Association, with HRSA funding support, announced awards to eight States for 
participation in a Policy Academy on Improving Oral Health Care of Children, with a second 
Academy planned for early next year. This program also will provide assistance in developing and 
implementing State-specific strategies. 
Thank you for your continued efforts to address the critical oral health needs of Medicaid children.  We 
look forward to hearing from you about how you plan to address oral health access problems of 
children in your State. 
Sincerely, 
/s/ 
Timothy M. Westmoreland 
Director 
Enclosures  Page 6 - State Medicaid Director 
cc: 

All HCFA Regional Administrators 

All HCFA Associate Regional Administrators 

for Medicaid and State Operations

Lee Partridge

Director, Health Policy Unit 

American Public Human Services Association 

Joy Wilson 

Director, Health Committee 

National Conference of State Legislatures

Matt Salo 

Director, Health Legislation 

National Governors' Association 

Brent Ewig 

National Association for State and 

Territorial Health Officials 

Claude Earl Fox, M.D. 

Administrator 

Health Services and Resources Administration
 TAB A 
CONSIDERATIONS IN ESTABLISHING MARKETPLACE-BASED 
DENTAL FEES 
The determination by Medicaid programs of appropriate dental reimbursement in the 
marketplace requires an understanding of the nature and economics of current dental practice. 
This TAB provides a brief overview of several factors that play important roles in such 
determinations: dental workforce supply and patient demand; dental practice factors; and 
methods for making prevailing fee comparisons. 
The supply of dental providers and demand for their services by the public are important 
underlying components in any assessment of the dental marketplace. While it is unclear if a 
national shortage of dentists and dental hygienists exists, the number of dentists relative to the 
Nations population has been in decline since 1990, when that ratio reached its zenith.  The 
decline in the absolute number of dentists has resulted from the net closure of six dental schools 
(from a high of 60 during the 1980s) along with an accompanying decrease in dental school 
class size, such that the equivalent of 20 additional average-size dental schools have been lost 
over the past two decades.  Only about 4,000 dentists have been produced annually since 
about 1990, compared to about 6,000 per year graduating in the late 1970s and early 1980s. 
An increasing retirement rate and declining hours of practice among an aging dentist population 
and other changes in the dental workforce suggest that no increase in the overall supply of 
dentists relative to the Nations population is likely over the next several decade. In some 
States--especially States with large rural, and/or low-income inner city populations--geographic 
maldistribution of dentists clearly is occurring with direct impact on competitive pricing for 
services.  Other dental and non-dental health care providers may play a role in provision of oral 
health services, but that potential remains largely restrained and untapped. 
On the demand side of the supply-demand equation, a growing and increasingly elderly 
population continues to have routine dental needs, a desire for aesthetic dental improvement, 
and an expectation--unlike earlier generations--that they can and will keep their dentitions intact 
for their entire lives.  Dental demand is elastic, and the long period of recent economic 
prosperity has generated substantial disposable income among those who otherwise might have 
considered the purchase of dental services to be discretionary. As a result, dental offices are 
maintaining busy practices and dentists average incomes currently are competitive with incomes 
earned by most primary care physicians. 
Although the dental workforce may not increase in size, projection of future dental supply and 
demand remains difficult; new scientific and technological breakthroughs, for example, may 
increase the productivity of the workforce and/or improve the oral health of the population. 
While such changes may impact on future ability to purchase dental services for State Medicaid  programs, knowledge of the current supply and demand situation provides some explanation as 
to why many dentists are unable or unwilling to provide care when fees are steeply discounted. 
Indeed, many dentists do not now accept any insurance, preferring to obtain their full charges 
from patients paying out-of-pocket. 
Exploration of other aspects of dental practice, especially in the context of Medicaid, facilitate 
further understanding of dentists practice-related economic decisions: 
	 Most dentists own and operate their own practices, and about 90 percent are solo 
practitioners or work with only one other dentist. The average dentist is responsible for all 
costs associated with managing the practice, and practice expenses as a percent of total 
annual billings are reported to be about 60-70 percent. The high cost of operating a dental 
practice places additional pressures on the dentist to avoid acceptance of discounted fees. 
	 The general dentists practice is more akin to a surgical practice than a primary care 
practice. A substantial part of the dentists time is spent directly in procedures involving 
cutting, removal and restoration of hard and soft tissue. The dentists work in the operatory 
requires the appointment of individual patients, and failure of the patient to attend the 
appointment without adequate prior notice creates down-time and lost income. The 
Medicaid clients reputation for breaking appointments--although not fully substantiated in 
the literature--has created a perception among dentists that their participation in the 
Medicaid program will adversely affect the economics of operating a successful practice. 
	 Dentists are unable to balance bill for Medicaid-covered procedures, whereas under 
most other insurance plans, patients remain responsible for paying the difference between 
the insurance payment for the covered service and the dentists usual charges. 
	 Medicaid clients often have significantly more complex oral health needs than are found in 
higher income populations, and treatment may require more clinical time per procedure. 
An understanding of prevailing fee methodologies is also of critical import in establishing 
marketplace-based reimbursement system.  In many State Medicaid programs, administrators 
have based their reimbursement schedules on the concept of UCR, or Usual, Customary 
and Reasonable. The terms may be defined, respectively, as follows: 
Usual fee: that fee that an individual dentist most frequently charges for a given dental 
service. 
Customary fee: that fee determined by the administrator of a dental benefit plan from 
actual submitted fees for a specific dental procedure to establish the maximum dental 
benefit payable under a given plan for a specific procedure.  Reasonable fee: the fee charged by a dentist for a specific dental procedure that has 
been modified by the nature and severity of the condition being treated and by any 
medical and dental complication or unusual circumstance, and, therefore, may differ 
from the dentists usual fee or the benefit administrators customary fee. 
In the commercial dental benefits sector, this approach usually means that individual dentists 
submit claims reflecting their usual charges to dental plans for procedures provided to covered 
beneficiaries, and the dentist is reimbursed either in full or at a modest discounted level of their 
submitted charges, up to a predetermined upper fee limit. This method appears to be adept at 
dealing with variations in individual dentists fee structures, and appears to be able to attract a 
broad segment of dental providers, to the degree that the discount on submitted fees is not 
excessive. The experience of commercial dental preferred provider networks in heavily 
competitive dental markets indicates that some providers may accept discounted fees in the 
range of 15-20 percent. At least one State Medicaid program is reported to be using this 
method for reimbursement, paying each dentist at 85 percent of each submitted charge. 
More commonly in the Medicaid program, the UCR concept has meant that the administrator 
bases the reimbursement schedule on the average fee submitted by all Medicaid participating 
dentists for procedures provided for Medicaid enrollees.  The figure is often obtained from the 
States Medicaid data base.  As interpreted by Medicaid programs, this use of UCR may not 
provide a valid reflection of market-based dental fees for several reasons: 
	 Medicaid programs often apply a discounted rate substantially greater than that used in 
commercial dental benefit programs, resulting in fees-for-services that are substantially less 
than prevailing fees. 
	 Many dentists submit charges to Medicaid that are equal to the amount Medicaid currently 
pays for a given procedure, rather than the charges they actually bill their non-Medicaid 
clients. This custom relates to the dentists recognition that they are bound by law to accept 
the Medicaid fee as payment in full for any covered procedure, and that billing Medicaid at 
the Medicaid fee instead of their usual charge eliminates the need to reconcile or write-off 
the difference for each procedure provided.  There is no incentive for dentists to make this 
accounting adjustment because they cannot balance bill Medicaid clients for the difference 
between Medicaid and their private-sector fees, as they would for their private sector 
clients. 
	 Most States Medicaid fee data bases are at least one year behind the private sector market 
because they contain fees submitted by dentists in the prior year.  Additionally, and perhaps 
more importantly, most Medicaid programs have no provisions for updating fee structures 
on a regular basis. Over the passage of a few years, the effect of not adjusting for the 
increase in the market prices for dental services is quickly compounded and the gap 
becomes wide.  The effect of Medicaid fee setting processes using UCR was described recently in an 
unpublished study cited by GAO investigators in their April 2000 Report. This study compared 
a sample of dentists fees in the private sector to Medicaid fees for the same services, and 
projected the proportion of dentists who might accept the Medicaid fees. The study indicates 
that the level of Medicaid dental reimbursement in 1999, nationally and in most States, was 
about equal to or less than the dental fees normally charged by the lowest 10th percentile of 
dentists, i.e., 90 percent of dentists charged more, and usually substantially more, than the 
Medicaid fee. 
Use of percentiles is exceptionally helpful for Medicaid programs as they enable estimation of 
the number of dentists in the State who might participate in Medicaid, given any chosen 
constellation of Medicaid fees.  States may then take actions to adjust dental payments so that 
their programs are likely to enlist sufficient dental providers and assure prompt access equal to 
that experienced by the general public. To compare Medicaid fees to fee percentiles in a State, 
you will need to obtain current data sets that describe the percentile distribution of fees that the 
States dentists routinely charge. Information on dentist/fee percentile distributions are available 
from commercial organizations, such as the Ingenix Corporations Prevailing Healthcare 
Charges System, or from other actuarially sound State-specific sources, such as those which 
may be available from commercial dental insurers. The American Dental Associations (ADA) 
Survey of Regional Fees, which offers regional rather than State-level fee distribution data, is an 
excellent alternative source of information, if State-specific prevailing fee data are otherwise 
unavailable.  (As noted previously, existing Medicaid claims data bases are not a good source 
for making dental fee comparisons). 
With due consideration of the implications of percentile comparisons, several States recently 
have moved to increase Medicaid reimbursement levels to considerably higher levels. In most 
cases it is too soon to tell if the rate increases made by these State are increasing dentist 
participation, and it is often difficult to separate the affect of fees from the impact of other non-
reimbursement programmatic changes being made concurrently. There is reason to believe, 
however, as noted by the GAO, that fees approaching prevailing private sector fees are more 
likely to result in increased dentist participation in Medicaid. 
The ADA believes that Medicaid fees that approach the 75th percentile will greatly improve the 
likelihood of dentists participating in the Medicaid program. The ADA has advised that it is 
prepared to work intensely with State programs that propose to move towards achieving such 
reimbursement levels. 
Please note, if a State delivers dental care through managed care arrangements, the State 
remains responsible for assuring that access to dental services for Medicaid enrolled 
children is achieved. Contracts between States and managed care entities should enable the 
State to ascertain if the plan has adequate provider capacity to provide the dental services 
needed by the plans service area population.  Payment rates must be adjusted to assure that 
plans are able to maintain a sufficient number, mix and geographic distribution of dental 
providers.  TAB B

REFERENCE MATERIALS

Spisak S, Holt K, eds. Building Partnerships to Improve Childrens Access to Medicaid Oral Health 
Services: National Conference Proceedings, Lake Tahoe, Nevada, June 2-4, 1998. Arlington, VA: National 
Center for Education in Maternal and Child Health,1999, v + 80p. 
Available on the Internet at: http://www.ncemch.org/oralhealth/PDFs/OH%20proceedings.pdf 
Copies are available from: 
National Maternal and Child Health Clearinghouse 
2070 Chain Bridge Road, Suite 450 
Vienna, VA 22182-2536 
(703) 356-1964 
(703) 821-2098 FAX 
American Dental Association. Achieving Improvement in Medicaid: Report of Aim for Change in 
Medicaid Conference, Chicago, Illinois, August 2-3, 1999. The Association, 1999, iii + 67. 
Copies are available from: 
Judy W. Pulice 
State Government Affairs 
American Dental Association 
211 East Chicago Avenue 
Chicago, IL 60611-2678 
(312) 440-3520 
(312) 440-3539 FAX 
pulicej@ada.org 
Epstein, CA. States Approaches to Increasing Medicaid Beneficiaries Access to Dental Services. Center 
for Health Care Strategies, October 2000, 24p. 
Available on the Internet at: http://www.chcs.org. Click on publications 
Copies are available from: 
Stephen A. Somers

Center for Health Care Strategies

353 Nassau Street

Princeton, NJ 08540

(609) 279-0700

(609) 279-0956 FAX

Nagy, Erin. Dental Care for Medicaid-Enrolled Children. American Public Human Services Association, 
July 2000. 15p. 
Available on the Internet at: http://medicaid.aphsa.org/pubs/pubs.htm#dentalcare 
Copies are available from: 
APHSA

810 First Street NE, Suite 500

Washington, DC 20002

(202) 682-0100

Perkins, J and Short J. State Initiatives to Improve Access to Dental Care. National Health Law Project, 
October 17, 2000  Available on the Internet at: http://www.healthlaw.org/pubs/200010dental.html 
Perkins, J. Docket of Medicaid Cases Filed to Improve Dental Access. Oct. 27, 2000 
Updated: Nov. 15, 2000. 
Available on the Internet at: http://www.healthlaw.org/pubs/200011dentaldocket.htm 
General Accounting Office. Oral Health: Factors Contributing to Low Use of Dental Services by Low-
Income Populations; United States General Accounting Office (GAO), Report to Congressional Requesters. 
HEHS-00-149, September 2000. 41p. 
Available on the Internet at: http://www.gao.gov  On GAO search engine, insert HEHS-00-149 
Copies are available for $2.00 each at: 
U.S. General Accounting Office 
P.O. Box 37050 
Washington, D.C. 20013 
General Accounting Office. Oral Health: Dental Disease is a Chronic Problem Among Low-Income 
Populations; United States General Accounting Office (GAO), Report to Congressional Requesters. HEHS-
00-72, April 2000. 44p. 
Available on the Internet at: http://www.gao.gov  On GAO search engine, insert HEHS-00-72 
Copies are available for $2.00 each at: 
U.S. General Accounting Office 
P.O. Box 37050 
Washington, D.C. 20013 
Fact Sheet Dental Coverage Under Medicaid; Community Voices, September 1999 
Available on the Internet at: http://www.stateaction.org/issues/healthcare/dental/dentalfactsh.pdf 
Copies are available from 
Center for Policy Alternatives 
1875 Connecticut Ave, NW, Suite 710 
Washington, DC 
Overview of State Legislation on Access to Oral Health. Center for Policy Alternatives. 1999 
Available on the Internet at: http://www.stateaction.org/issues/healthcare/dental/overview.cfm 
U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon 
General. Rockville, MD: U.S. Department of Health and Human Services , National Institute of Dental and 
Craniofacial Research, National Institutes of Health, 2000. 
Available on the Internet at: http://www.cdc.gov/nccdphp/oh/sgr2000-05.htm 
Center for Health Services Research and Policy. Sample Purchasing Specifications for Medicaid Pediatric 
Dental and Oral Health Services. George Washington University Medical Center, March 10, 2000. 
Available on the Internet at: http://gwu.edu/~chsrp Click on Sample Purchasing Specifications  TAB C

HCFA REGIONAL MEDICAID DENTAL COORDINATORS

Region I, Boston  Region IV, Atlanta 
Elena Byrne
 Roberta Kelley

Health Care Financing
 Health Care Financing Administration

Administration/Medicaid
 61 Forsyth Street, S.W., Suite 4T-20

Department of Medicaid and State 
 Atlanta, GA 30303-8909

Operations
 Telephone: (404) 562-7461

JFK Federal Building, Room 2275
 Fax: (404) 562-7481

Boston, MA 02203
 Email: rkelley@hcfa.gov

Telephone: (617) 565-1243

Fax: (617) 565-1083
 Dianne Thornton

Email: ebyrne@hcfa.gov
 Health Care Financing Administration

61 Forsyth Street, S.W., Suite 4T-20

Region II, New York  Atlanta, GA 30303-8909

Richardo Holligan
 Telephone: (404) 562-7464

Health Care Financing Administration
 Fax: (404) 562-7481

Division of Medicaid and State Operations
 Email: dthornton@hcfa.gov

26 Federal Plaza

New York, NY 10278
 Region V, Chicago 
Telephone: (212) 264-3978
 Beverly L. Jones

Email: rholligan@hcfa.gov
 Health Care Financing Administration

Region V

Nicole McKnight
 233 North Michigan Avenue, Suite 600

Health Care Financing Administration
 Chicago, IL 60601-5519

Division of Medicaid and State Operations
 Telephone: (312) 353-3721

26 Federal Plaza
 Fax: (312) 353-3866

New York, NY 10278
 Email: bjones2@hcfa.gov

Telephone: (212) 264-2590

Email: nmcknight@hcfa.gov
 Region VI, Dallas 
Scott Harper

Region III, Philadelphia  Health Care Financing Adminstration

Elizabeth Wheeler
 1301 Young Street, Suite 833

Health Care Financing Administration
 Dallas, TX 75202

Region III
 Telephone: (214) 767-6564

The Public Ledger Building, 2nd Floor
 Fax: (214) 767-0322

150 South Independence Mall West, 
 Email: sharper@hcfa.gov

Philadelphia, PA 19106-3499

Telephone: (215) 861-4190

Fax: (215) 861-4280

Email: ewheeler@hcfa.gov
 Region VII, Kansas City 
Gail Brown-Stevenson

Health Care Financing Administration

Region VII

Federal Building, Room 227

601 East 12th Street

Kansas City, MO 64106

Telephone: (816) 426-3406

Fax: (816) 426-3851

Email: gbrown2@hcfa.gov

Region VIII, Denver 
Dee Raisl

Health Care Financing Administration

Region VIII

Division of Medicaid and State Operations

1600 Broadway, Suite 700

Denver, CO 80202

Telephone: (303) 844-2682

Fax: (303) 844-2776

Email: draisl@hcfa.gov

Region IX, San Francisco 
Kaihe Akahane

Health Care Financing Administration

75 Hawthorne Street, 4th Floor

San Francisco, CA 94105

Telephone: (415) 744-2976

Fax: (415) 744-2933

Email: kakahane@hcfa.gov

Region X, Washington 
Linda Miles

Health Care Financing Administration

Region X

2201 6th Avenue

Seattle, WA 98121

Telephone: (206) 615-2343

Fax: (206) 615-2472

Email: lmiles@hcfa.gov