Because Medicaid generally pays less than private insurers for equivalent services, it is widely perceived that this gap results in reduced access to care, including dental care, for Medicaid patients. This includes children, about one-third of whom are covered by public health insurance plans.
About one-fourth of all children aged 2 to 8 years have untreated cavities. Children with poor dental health are at risk for ear and sinus infections and a variety of other avoidable health problems that affect their current and future quality of life.
In an article in this week’s JAMA, Sandra Decker, PhD, an economist at the US Centers for Disease Control and Prevention, describes how Medicaid fees affect preventive dental care for children. Dr Decker discusses her findings:
news@JAMA: Did you find some absolute level of reimbursement for preventive dental care that was associated with children receiving adequate care?
Dr Decker: I found that higher reimbursement rates were associated with an increased likelihood that children on Medicaid received dental care at similar rates compared to privately insured children. The exact rate at which this will be true will depend on the state and the level of other fees like those for private insurance in the state. Also, not all privately insured children receive the recommended amount of dental care.
news@JAMA: Do you think access to care for other types of services is as sensitive to reimbursement policies as was dental care?
Dr Decker: I do, and I believe that ongoing research into the sensitivity of different types of care to reimbursement levels is of growing importance. Public health programs are growing, with continuous pressure in both the Medicaid and Medicare programs to contain costs by lowering provider payment rates. More research on the impact of these policies is definitely needed. Medicaid payment rates for office-based physicians are very low in many states. I believe that this affects the care patients receive in ways that need to be better documented.
news@JAMA: Is there any indication that states are working to improve this situation?
Dr Decker: Some states have recognized the problem and have raised fees. This is true particularly for obstetrics in some states. I believe that this has had a positive impact on participation of [obstetricians] in the Medicaid program. But Medicaid fees remain very low in many states.
news@JAMA: Are problems with access to dental care for children on Medicaid getting better or worse?
Dr Decker: I believe the evidence is very encouraging. Several states considerably raised Medicaid dental fees between 2000 and 2008. Although there is obviously some short-term cost of this policy change for state Medicaid programs, my research does indicate that these changes positively impacted children’s use of dental care. Several states have also initiated programs to educate families on the importance of dental care, conducted outreach programs to dentists to improve referral networks, strengthened managed care programs, and have undertaken other policies that have likely positively impacted Medicaid children’s use of dental care. I found that, nationally, use of dental care among children on Medicaid improved significantly between 2000 and 2008.
news@JAMA: Do you have a sense for how much money would be saved over one’s lifetime by avoiding dental caries by investing in preventive dental care for children?
Dr Decker: I have not personally investigated this question per se. I believe a lot of preventive care is worth investing in even if it does not save money. Improvements in quality of life are worth paying for even if they are not cost reducing. But my sense is that investment in preventive dental services may be one area where investment may indeed considerably reduce the need for future, more expensive treatments.