Medicaid Payment Levels to Dentists and Access to Dental Care Among Children and Adolescents

Context Although Medicaid removes most financial barriers to receipt of dental care among children and adolescents, Medicaid recipients may not be able to access dental care if dentists decline to participate in Medicaid because of low payment levels or other reasons. Objective To describe the association between state Medicaid dental fees in 2 years (2000 and 2008) and children's receipt of dental care. Design, Setting, and Participants Data on Medicaid dental fees in 2000 and 2008 for 42 states plus the District of Columbia were merged with data from 33 657 children and adolescents (aged 2-17 years) in the National Health Interview Survey (NHIS) for the years 2000-2001 and 2008-2009. Logit models were used to estimate the probability that children and adolescents had seen a dentist in the past 6 months as a function of the Medicaid prophylaxis fee and control variables including age group, race, poverty status, and state and year effects. The effect of fees on children with Medicaid relative to a control group, privately insured counterparts, served to separate Medicaid's effect on access to care from any correlation between the Medicaid fee or changes in fees by state and other attributes of states. Main Outcome Measure Whether a child or adolescent had seen a dentist in the past 6 months. Results On average, Medicaid dental payment levels did not change significantly in inflation-adjusted terms between 2000 and 2008, although a difference existed for some states, including in 5 states plus the District of Columbia, where payments increased at least 50%. In 2008-2009, more children and adolescents covered by Medicaid (55%, 95% confidence interval [CI], 53%-57%) had seen a dentist in the past 6 months than did uninsured children (27%, 95% CI, 24%-30%), but fewer than children covered by private insurance (68%, 95% CI, 67%-70%). Changes in state Medicaid dental payment fees between 2000 and 2008 were positively associated with use of dental care among children and adolescents covered by Medicaid. For example, a $10 increase in the Medicaid prophylaxis payment level (from $ 20 to $30) was associated with a 3.92 percentage point (95% CI, 0.54-7.50) increase in the chance that a child or adolescent covered by Medicaid had seen a dentist. Conclusion Higher Medicaid payment levels to dentists were associated with higher rates of receipt of dental care among children and adolescents. JAMA. 2011;306(2):187-193 www.jama.com