Managed Care for Oral Health: What’s Next for North Carolina’s Medicaid Transformation?

“Managed Care” is transforming Medicaid in states across the country. In many cases, including in North Carolina, oral health is not included in the programs that promise a shift toward value-based care. As North Carolina approaches the next phase in its Managed Care program, could, and should, oral health be included? NCOHC’s newest partnership plans to convene stakeholders across the state to find out.

A collection of state-run programs, Medicaid has traditionally been operated on a “fee for service” basis, in which government agencies across the country pay out claims for health services based on volume. For decades, this model has prevailed in both medical and oral health care.

The Shift to Managed Care

Recently, however, state-administered Medicaid programs have begun to embrace an alternative payment model. In its simplest form, “managed care” turns management of Medicaid health plans over to private insurers, paying them a set rate per patient to deliver all services necessary to keep beneficiaries healthy. Ideally, managed care supports a shift to “value-based care,” in which reimbursement policies incentivize prevention and improved patient outcomes.

Managed Care and Oral Health

Unfortunately, the national shift to Medicaid managed care has in many cases reinforced long standing “siloes” that artificially separate medical care from oral health care. In North Carolina, for instance, the state’s Medicaid program transitioned to managed care on July 1, 2021, but the initial launch only included primary care and behavioral health services. As seen in various other states, oral health care was essentially “carved out” of the new system.

With the health of so many at stake and the investment so significant, we at the North Carolina Oral Health Collaborative (NCOHC) felt it critical to ensure that consideration of the potential shift to oral health managed care includes the voices and perspectives of diverse stakeholders. While the consensus among North Carolina providers and policymakers seems to be that oral health care will be integrated into Medicaid managed care in the future, we hope that collective engagement will help inform and support the potential transition as seamlessly and effectively as possible.

Oral Health Transformation Initiative

To that end, NCOHC is partnering with the North Carolina Institute of Medicine (NCIOM) on a Medicaid Oral Health Transformation Initiative, designed to evaluate best practices and make recommendations for oral health’s potential inclusion in NC Medicaid Managed Care efforts.
The two-year, three-phase project will be led by multi-disciplinary, cross-sector stakeholders and Task Force members engaged in oral health and health care across North Carolina.

The Task Force will draw upon a systematic literature review and key informant interviews with those in and outside North Carolina. Recommendations will be compiled in a final report to be delivered to policymakers and legislators as they consider a potential transition to Medicaid managed care for oral health. This work will be completed just in time for the 2024 expiration (and subsequent renewal) of the federal 1115 Demonstration Waiver that paved the way for the current iteration of North Carolina’s Medicaid Managed Care.


To learn more, please visit our Oral Health Transformation Initiative page.

NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.


What Are Dental Sealants?

Sometimes, the best prevention is a layer of protection. Take a baking sheet out of the oven and you’ll probably protect your hand from the heat with an oven mitt or towel. Go out in the rain and a raincoat or umbrella is your best bet if you want to stay dry. In this blog post, we’ll explain what dental sealants are — and how they function in a similar way.

Protecting our teeth is essential. Dental sealants add a layer of protection to your teeth, helping ward off decay-causing acids, sugars, and bacteria. They are an especially effective option for children, in part because insurance often covers them up to a certain age. Sealants are about as simple as they sound, and they are a great way to keep your teeth healthy and protected from cavities. When it comes to prevention, sealants are a fantastic option.

How Do Sealants Work?

Dental sealants act as coatings, filling in any pits or grooves on a chewing surface to form a protective layer over a tooth’s enamel.

Typically, sealants are applied to the chewing surfaces of molar teeth, but they can be applied elsewhere as needed. For example, sometimes sealants can be placed on the back surface of a front tooth that has exceptionally deep grooves.

Sealants may be applied by a dentist or, depending on the specific state’s laws, a dental hygienist or dental assistant. In some states, physicians and other medical staff may also apply dental sealants.

What are Sealants Made of?

Sealants are typically applied in the form of a liquid resin that becomes hard when cured. If you ever had a sealant applied, a cavity filled, braces attached, or any similar dental procedure, you may remember your dentist or hygienist using a tool that almost looks like an electric toothbrush without any bristles.

That tool is what “cures” the liquid sealant, leaving behind a rigid, protective layer.

Do Sealants Work?

Yes, sealants are very effective. According to the CDC, dental sealants can prevent 80 percent of cavities for two years. They have been proven to protect against 50 percent of cavities for up to four years, and there is evidence that they can work for up to nine years.

It is easy for a provider to tell when a sealant either falls off or is worn away, and fortunately they are easy to replace!

Are Dental Sealants Safe?

It is important to note concerns about BPA entering a patient’s system from dental sealants. Fortunately, several studies have been conducted to measure BPA exposure from sealant application, and the widespread consensus is that they are completely safe.

Some BPA may be detectible in a patient’s saliva hours after a sealant is applied, but no associated increase in BPA levels has been detected in patients’ blood at any time post-sealant application.

BPA can imitate a person’s naturally produced hormones, causing an array of health issues. It is an important environmental concern, but fortunately, dental sealants are not a source for concern.

In fact, breathing in dust or touching a receipt will expose a person to much more BPA than a dental sealant application.

How Much Do Sealants Cost?

Some dental plans cover sealants, especially for children. For patients without insurance or with insurance that doesn’t cover sealants, they typically cost between $30 and $75 per tooth. This is a lot more affordable compared to the price of a filling ($150-$450) or other more invasive treatment.

The cost can vary by provider, insurance, and material used, so it is important to ask your dentist to get a better idea of the price tag for dental sealants.

NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.