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. 2022 Sep 2;3(9):e223041.
doi: 10.1001/jamahealthforum.2022.3041.

Association Between Medicaid Dental Payment Policies and Children's Dental Visits, Oral Health, and School Absences

Brandy J Lipton  1   2 , Sandra L Decker  3 , Brittney Stitt  1 , Tracy L Finlayson  1 , Richard J Manski  3   4
Affiliations

Association Between Medicaid Dental Payment Policies and Children's Dental Visits, Oral Health, and School Absences

Brandy J Lipton et al. JAMA Health Forum. .

Abstract

Importance: Although all state Medicaid programs cover children's dental services, less than half of publicly insured children receive recommended care.

Objective: To evaluate the association between the ratio of Medicaid payment rates to dentist charges for an index of services (fee ratio) and children's preventive dental visits, oral health, and school absences.

Design, setting, and participants: In this cross-sectional study, a difference-in-differences analysis was conducted between September 2021 and April 2022 of 15 738 Medicaid-enrolled children and a control group of 16 867 privately insured children aged 6 to 17 years who participated in the 2016-2019 National Survey of Children's Health. Exploratory subgroup analyses by sex and race and ethnicity were also performed. A 2-sided P < .05 was considered significant.

Main outcomes and measures: Past-year preventive dental visits (at least 1 and at least 2), parent-reported excellent oral health, and number of days absent from school (at least 4 days and at least 7 days).

Results: The Medicaid-enrolled sample included a weighted estimate of 51.20% boys and 48.80% girls (mean age, 11.24 years; Black, 21.65%; Hispanic, 37.75%; White, 31.45%). By weighted baseline estimates, 87% and 48% of Medicaid-enrolled children had at least 1 and at least 2 past-year dental visits, respectively, and 29% had parent-reported excellent oral health. Increasing the fee ratio by 1 percentage point was associated with percentage point increases of 0.18 in at least 1 dental visit (95% CI, 0.07-0.30), 0.27 in at least 2 visits (95% CI, 0.04-0.51), and 0.19 in excellent oral health (95% CI, 0.01-0.36). Increases in at least 2 visits were larger for Hispanic children than for White children. By weighted baseline estimates, 28% and 15% of Medicaid-enrolled children had at least 4 and at least 7 past-year school absences, respectively. Regression estimates for school absences were not statistically significant for the full sample but were estimated to be significantly reduced among girls.

Conclusions and relevance: This cross-sectional study found that more generous Medicaid payment policies were associated with significant but modest increases in children's preventive dental visits and excellent oral health. Further research is needed to understand the potential association between policies that improve access to dental care and children's academic success.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Manski reported receiving grants from the National Institutes of Health and consultant fees as an Agency for Healthcare Research and Quality senior scholar and from a subcontract from San Diego State University during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Medicaid Fee-for-Service Reimbursement as a Percentage of Fees Charged by Dentists by State in 2019
Analysis of state fee schedules from state Medicaid websites and the 2018 and 2020 American Dental Association Survey of Dental Fees., More details on the construction of the fee ratio are available in eAppendix 1 in the Supplement.
Figure 2.
Figure 2.. Trends in at Least 1 Dental Visit in States With a 2018-2019 Fee Ratio Change
Outcome rates are weighted using sampling weights available from the 2016-2019 National Survey of Children’s Health. The sample includes children in the main study sample who resided in 1 of 9 states that first had a year-over-year fee ratio change of at least 2 percentage points in 2018 or 2019. These states were Alaska, Arizona, Connecticut, Mississippi, Montana, North Carolina, Oregon, South Dakota, and Utah. The sample includes 3420 Medicaid-enrolled children and 2923 privately insured children.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention . Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999-2004 to 2011-2016. US Department of Health and Human Services; 2019.
    1. Guarnizo-Herreño CC, Wehby GL. Children’s dental health, school performance, and psychosocial well-being. J Pediatr. 2012;161(6):1153-1159. doi:10.1016/j.jpeds.2012.05.025 - DOI - PMC - PubMed
    1. Agaku IT, Olutola BG, Adisa AO, Obadan EM, Vardavas CI. Association between unmet dental needs and school absenteeism because of illness or injury among U.S. school children and adolescents aged 6-17 years, 2011-2012. Prev Med. 2015;72:83-88. doi:10.1016/j.ypmed.2014.12.037 - DOI - PubMed
    1. Jackson SL, Vann WF Jr, Kotch JB, Pahel BT, Lee JY. Impact of poor oral health on children’s school attendance and performance. Am J Public Health. 2011;101(10):1900-1906. doi:10.2105/AJPH.2010.200915 - DOI - PMC - PubMed
    1. Detty AM, Oza-Frank R. Oral health status and academic performance among Ohio third-graders, 2009-2010. J Public Health Dent. 2014;74(4):336-342. doi:10.1111/jphd.12063 - DOI - PubMed

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