Many Pa. Children on Medicaid Lack Adequate Dental Care, Says Report by GSPH Medicaid Policy Center

Judith Lave

Despite program improvements, a significant number of children in Pennsylvania covered by Medicaid do not receive basic dental health services that could help prevent serious medical problems, according to a report published online by the Pennsylvania Medicaid Policy Center (PMPC) at the University of Pittsburgh Graduate School of Public Health (GSPH).

The report found that the majority of children on Medical Assistance are enrolled in managed care, but only 42.8 percent of these children had an annual dental visit in 2009. These services included periodic oral exams and diagnostic and preventive care, such as fillings and fluoride treatment. One main obstacle to low-income children receiving adequate dental health services is a shortage of dentists who will accept Medical Assistance, the report’s authors said.

Medical Assistance covered more than one million, or 35.5 percent, of all children in Pennsylvania in 2009. In 2008, Medical Assistance spent about $124.9 million on dental services, or $109 per enrolled child.

According to the report, Pennsylvania dentists may be reluctant to participate in Medical Assistance because of reimbursement rates, which are low compared to other Medicaid programs nationally and are set at about 53.2 percent of regular dental service fees. However, Pennsylvania recently implemented a number of initiatives to improve dental provider participation in Medical Assistance and recipient access to services, among them the creation of the ACCESS Plus Dental Care/Disease Management Program.

“We found that only 26 percent of practicing dentists in Pennsylvania were reimbursed by Medical Assistance in 2009,” said Judith R. Lave, PMPC director and a professor of health economics in GSPH. “Medical Assistance may need to reexamine reimbursement practices to ensure services are being appropriately covered. This could help encourage more dentists to participate in the program and improve access to care for low-income children. We recognize the state’s financial problems and are concerned that the current budget crisis may lead to pressure to reverse the program improvements.”

The report presents data from the Pennsylvania Department of Public Welfare concerning Medical Assistance enrollment, dental expenditures, managed care performance, and active dentists. The Pennsylvania Department of Public Health and Department of State survey results were used for the number of dentists providing direct patient care and insurance acceptance in Pennsylvania.

Monica R. Costlow, a PMPC senior policy analyst, coauthored the report, which can be viewed at www.pamedicaid.pitt.edu/documents/Dental_rp_10_8_.pdf.