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Half of Medicaid-insured children never visit a dentist, and many who do are not given needed care

States are required by Federal law to provide dental care to all Medicaid-eligible children from birth to 21 years of age. The children are supposed to receive an annual dental exam, prophylaxis and fluoride treatment, dental sealants, and other emergency, preventive, and restorative services. However, if a recent study of North Carolina's Dental Medicaid Program is any indication, half of Medicaid-insured children never use dental services, and of those who do, 43 percent do not receive needed dental care. This is partly because most Medicaid enrollees in North Carolina use dental services sporadically. For instance, nearly half (46 percent) of the children studied sought care for only 1 year.

Streamlining Medicaid administrative procedures (e.g., Medicaid eligibility, treatment approval) could contribute to better care for these children, according to the study, which was supported in part by the Agency for Health Care Policy and Research (HS06993 and National Research Service Award training grant T32 HS00032). For example, instituting a mechanism for prior approval of care once a child appears for his or her first dental visit would help to ensure that all needed care could be completed quickly and without the need for further approvals.

The researchers analyzed data from 1986 and 1987 State-wide clinical records of treatment need, Medicaid dental claims data from 1984 through 1992 on treatment received, and Medicaid enrollment files from 1984 through 1992. They found that half of Medicaid-enrolled children never used dental services. Among users, 45 percent and 25 percent of children needed restorations in primary and permanent teeth, respectively. Among these children, 29 percent had all dental needs met, 28 percent had needs partially met, and 43 percent had no dental needs met. Despite Federal guidelines calling for the use of sealants in Medicaid-eligible children, dentists used sealants infrequently and only for a small number of children.

For more information, see "A longitudinal study of schoolchildren's experience in the North Carolina dental Medicaid program, 1984 through 1992," by Valerie A. Robison, D.D.S., Ph.D., M.P.H., R. Gary Rozier, D.D.S., M.P.H., and Jane A. Weintraub, D.D.S., M.P.H., in the November 1998 American Journal of Public Health 88(11), pp. 1669-1673.

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