Medicaid Policy Reform on Dental Utilization Rates for Children

Objective: Access to dental services is a known factor in the oral health and development of children. As such, the U.S. federal government mandates each state include dental services for children enrolled in Medicaid through the age 21. Despite this mandate, the utilization rate of dental services among Medicaid enrolled children has remained remarkably low. In July 2005, Virginia implemented sweeping Medicaid policy reform specifically aiming to increase Medicaid pediatric dental utilization rates. This study examines the impact of the 2005 Virginia Medicaid policy reform on the utilization of dental services among Medicaid enrolled children.

Methods: This was a retrospective cohort study of children (pre-reform n=559,820, post-reform n=690,538) enrolled in Virginia Medicaid from 2002 through 2008. Descriptive statistics and repeated measures multivariate logistic regressions were used to determine the relationship between enrollment (Pre- and Post-policy reform) and the utilization of dental services (1+ Dental Visits vs. No Dental Visits). The study was approved for human subjects by the Virginia Commonwealth University Institutional Review Board and is supported by a NIH/NIDCR grant (K22DE016084) and by the Virginia Department of Medical Assistance Services.

Results: Overall, 34% of pre-reform children had a dental visit while 44% of post-reform children. The final logistic regression models revealed that children in the post reform period were 1.39 as likely to have had a dental visit. Stratifying for enrollment length reveals that as the length of exposure time to the post-reform policy increases, the odds of having a dental visit also increase as compared to the pre-reform period: for 31-36 months of enrollment the odds increase 1.54 times.

Conclusions: Medicaid policy reform can significantly improve access to dental services for children and can therefore play an important role in promoting public health.