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Children's Health

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Expanded Medicaid and higher reimbursement rates only marginally improve access to dental services for poor children

Expansion of Medicaid eligibility in North Carolina from 1985 to 1991 doubled enrollment for individuals under age 21. Yet this expansion and a 23 percent increase in Medicaid reimbursement to dentists from 1988 to 1991 only marginally increased access to dental care for Medicaid-insured children, according to a study supported by the Agency for Healthcare Research and Quality (HS09330).

The percentage of dentists seeing five or more Medicaid-insured children per quarter remained fairly constant, and the percentage of dentists seeing 10 or more such children per quarter increased only slightly. The 23 percent nominal increase in fees over the study period also failed to influence the likelihood of dental participation. Greater participation may require much larger increases in reimbursement, concludes the study's first author Michelle L. Mayer, R.N., M.P.H., Ph.D., of Stanford University.

Dr. Mayer and colleagues analyzed North Carolina Medicaid dental claims from 1985 through 1991 and associated Medicaid eligibility and provider files, as well as dentists' data from the Cooperative Health Information System Provider file. Among those providers seeing at least 10 Medicaid children per quarter, an increase in real Medicaid reimbursement from $13 to $14 yielded an expected 3 percent (.83 person) increase in the number of Medicaid children seen per quarter.

Pediatric dentists were significantly more likely to participate in Medicaid than general dentists (probability of .578 vs. .198). Pediatric dentists also saw more than 2.5 times as many Medicaid children per quarter as general dentists, holding other factors constant. Dentists in solo versus group practices were more likely to participate in Medicaid, and dentists with more years of experience were less likely to participate. Dentists may be willing to accept lower reimbursement for Medicaid patients provided the rates are sufficiently high to avoid or minimize the financial loss associated with seeing these patients.

See "The effects of Medicaid expansions and reimbursement increases on dentists' participation," by Dr. Mayer, Sally C. Stearns, Ph.D., Edward C. Norton, Ph.D., and R. Gary Rozier, D.D.S., M.P.H., in the Spring 2000 Inquiry 37, pp. 33-44.

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