Policy Levers to Support the Transition From Pediatric to Adult Dental Care for People With Intellectual and Developmental Disabilities

People with intellectual and developmental disabilities (IDD) and their families and caregivers are faced with navigating two very different delivery and financing systems in dentistry: one during childhood and the other-often very disjointed-in adulthood. Even in states that offer Medicaid dental coverage for adults, the services are often substantially reduced, and the provider base to find a dentist is drastically diminished. Pediatric dentists encounter difficulty finding colleagues willing to take on the care of their patients with IDD as they reach adulthood. As a nation, we prioritize the health and wellbeing of children with disabilities via Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. By not establishing this bar of coverage through adulthood, U.S. policy limits the return on investment of EPSDT not only fiscally, but more importantly, in the health and quality of life of people with IDD as they progress into adulthood. Here we review policy prospects in disability services and dental care that could improve the transition experience and outcomes for patients, families, and providers. Within the disabilities realm, policies related to Home and Community Based Services, Long-Term Services and Supports, Dual-Eligible Special Needs Plans, HEADs UP Act, and EPSDT extension for IDD are considered. Dental policy opportunities explored relate to code development for transition implementation, quality measurement, and building upon existing clinical support tools for transition implementation. We assess the variety of stakeholder support and other inputs necessary and describe opportunities and challenges with our current day political environment.