According to a report published in the July 13 issue of JAMA, between the years 2000 and 2008, although children and adolescents in the U.S that had higher Medicaid payment levels to dentists were more likely to receive dental care, they still received dental care less often compared to children with private insurance.
As stated in the background information accompanying the article, more than one third of the children in the U.S are believed to be covered under different public health insurance schemes, such as Medicaid and Children’s Health Insurance Program (CHIP). Although it is a requirement that the dental care of children and adolescents in the U.S be covered by public health insurance schemes, there are no specific standards for setting the payment rates of dentists and other providers, and the rates vary significantly from one state to another.
It is to be understood that people covered by Medicaid may not be able to avail dental care if the dentists do not agree to participate in Medicaid. This may occur if the payment rates to dentists are less or for any other reason. Not much about the effects of state dental fees on the level of participation of the dentists in Medicaid program is known.
A study was conducted by Sandra L. Decker, Ph.D., from the Centers for Disease Control and Prevention, Hyattsville, Md., to understand the association of state dental care payment rates under the Medicaid program with the receipt of dental care among children covered by Medicaid.
Data about the Medicaid dental fees between the years 2000 and 2008 were obtained from 42 states plus the District of Columbia. These data were merged with the information obtained from the National Health Interview Survey (NHIS) for the years 2000-2001 and 2008-2009, which included the information of 33,657 children and adolescents, aged between 2 to 17 years.
The analysis of the study revealed that out of all the 42 states plus the District of Columbia, the Medicaid dental fees for the year 2008 were lower than the year 2000 in 23 states. In 19 states, including the District of Columbia the payment rates for dentists were higher in the year 2008 than in 2000. Furthermore, between 2000 and 2008 the payment rates increased by 50 % in five states (Connecticut, Indiana, Montana, New York, and Texas) including the District of Columbia.
The investigators also found out that the chances for a child or adolescent visiting a dentist in the past 6 months varied depending upon the source of insurance they are covered by. Moreover, in the year 2008-2009, children and adolescents covered by private insurance were more likely to see a dentist (68 percent) in the past 6 months, than the children or adolescents covered by Medicaid (55 percent) and without insurance (27 percent).
The researchers write:
“Children were about 6 percentage points more likely to have seen a dentist in 2008-2009 than in 2000-2001.. Those covered by Medicaid or CHIP were about 13 percentage points and uninsured children were about 40 percentage points less likely than children with private insurance to have seen a dentist.”
The authors stated:
“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 increase in the chance that a child or adolescent covered by Medicaid had seen a dentist. As future expansions in Medicaid eligibility and insurance coverage more generally are contemplated and possibly implemented, more attention to the effects of provider payment policies on access to care, quality of care, and health outcomes may be warranted.
Sandra L. Decker, PhD
JAMA. 2011;306(2):187-193. doi: 10.1001/jama.2011.956
Written by Barry Windsor