ow reimbursements to dentists from Medicaid make getting dental care difficult for children and adolescents covered by the government health plan, new research suggests.
Sandra L. Decker, senior service fellow in the division of health care statistics at the U.S. Centers for Disease Control and Prevention, found that in states with the highest Medicaid payments, children were more likely to get dental care, although they received care less often than children with private insurance.
"This may be partly because a lot of dentists don't participate in the Medicaid program, so they don't treat children with Medicaid," Decker said.
"In a lot of states, Medicaid dental fees are very low, so a dentist doesn't want to treat a Medicaid patient," she said. "So, low fees affect whether children on Medicaid get care."
The good news is that in states that raised their Medicaid reimbursements more children were able to find dental care, Decker said. "Some of those children were receiving dental care at the same rate as privately insured children," she noted.
But this progress may be in danger as states look for ways to cut costs. At a time when state budgets are being slashed, it is likely that reimbursements for dental care won't go up and may even be reduced, she added.
The report was published in the July 13 issue of the Journal of the American Medical Association.
Dr. Judy Schaechter, associate chair of pediatrics at the University of Miami Miller School of Medicine, said that "the relationship between type of insurance and visiting a dentist is well established."
But, "what this paper adds is that it reveals the direct relationship between Medicaid fee and provision of care," she said.
The reasons connecting fees to access are many, Schaechter said. "Among them are that fewer dentists will accept the lower fees, which hardly cover their costs for cleaning let alone their responsibility when they find severe dental disease," she said.
A recent study showed that some dentists agree to participate in Medicaid, and then make it difficult for Medicaid patients to see them for dental care, Schaechter added.
"From the patient perspective, if that happens enough, they think no one will see them. They give up trying to find a Medicaid dentist," she said. "Finally, with little to no financial incentives, neither dentists nor the Medicaid dental insurers are motivated to do sufficient outreach and educate families about coverage and the need to get preventive care at least every six months."
States are obligated to provide children with the same access and quality of health care through Medicaid as they would get with private insurance, Schaechter said. "We simply can't do that if we are not willing to pay for it."
For the latest study, Decker used data from the National Health Interview Survey from 2000-2001 on 33,657 children and adolescents, along with data on Medicaid dental fees in 2000 and 2008 in 42 states and the District of Columbia.
She found that in 23 states, the 2008 Medicaid dental fees were lower than they were in 2000 (after adjusting for inflation). In 19 states and the District of Columbia, Medicaid fees were higher in 2008 than in 2000.
In Connecticut, Indiana, Montana, New York, Texas and the District of Columbia, Medicaid payments to dentists increased by at least 50% between 2000 and 2008, Decker said.
Whether a child or adolescent had seen a dentist in the past six months was dependent on the type of insurance they had, Decker found.
In 2008 and 2009, children on Medicaid were less likely to see a dentist compared with children with private insurance (55% versus 68%, respectively) in the past six-month period. However, both groups were more likely to see a dentist than children without any coverage (27%), the study found.
As payments for dental care increased, children on Medicaid were more likely to see a dentist, Decker said. For example, a $10 increase in Medicaid payments for a check-up, from $20 to $30 between 2000 and 2008, increased the likelihood that a child would see a dentist by 3.92%.
More than one-third of children in the United States are covered by public health insurance, primarily Medicaid and the Children's Health Insurance Program. Covering dental care for children and adolescents is required by these programs.
However, states can set payment rates for dentists, so these rates vary by state. In addition, dentists are not required to see Medicaid patients.