A tale of two public dental benefit programs: Iowa dentist participation in traditional Medicaid versus a Medicaid expansion program

Abstract

Background In Iowa from 2014 to 2017, there were 2 separate public dental benefit programs for Medicaid-enrolled adults: one for the Medicaid expansion population called the Dental Wellness Plan (DWP), and one for the traditional, non-expansion adult Medicaid population. The programs differed with respect to reimbursement, administration, and benefit structure. This study explored differences in patterns and predictors of dentist participation in the two programs. Methods Authors sent a survey to all private practice dentists in Iowa ( n = 1301) 2 years after DWP implementation. Descriptive, bivariate, and logistic regression analyses were used to examine patterns and predictors of dentist participation in Medicaid and DWP. Results Overall rates of dentists’ acceptance of new Medicaid and DWP patients were 45 and 43%, respectively. However, Medicaid participants were much more likely than DWP participants to place limits on patient acceptance. Adjusting for other factors, practice busyness was the only significant predictor of DWP participation, and practice location was the only significant predictor of Medicaid participation. Dentists who were not busy enough were more than twice as likely to participate in DWP compared to others, and dentists in rural areas were almost twice as likely to participate in Medicaid compared to dentists in urban areas. Conclusions Dentist participation in Medicaid is an ongoing concern for states aiming to ensure access to dental care for low-income populations. We found distinct participation patterns and predictors between a traditional Medicaid dental program and the DWP, suggesting different motivations for participation between the two programs. Electronic supplementary material The online version of this article (10.1186/s12903-019-0771-z) contains supplementary material, which is available to authorized users.

The association of dental education with pediatric Medicaid participation

“…Prior research shows dental care use is lower when Medicaid dental reimbursement rates are low compared with private insurance rates. [4][5][6][7][8] Other factors associated with Medicaid participation include whether being a member of a racial/ethnic minority, practicing in rural areas, and having altruistic attitudes [9][10][11][12][13] How and where dentists were trained could affect dentists' practice choices. Dental students with higher educational debt are more inclined to prefer private practice and to join dental service organizations (DSOs) and are less likely to seek government service, although debt was not significantly associated with the percent of poor patients in their practices, nor with participation in public programs.…”

Applying “Stages of Readiness to Change” Model to Dentists’ Decisions to Participate in Medicaid: An Exploratory Study

“…One significant change that occurred in Iowa state since data collection for this study was the Iowa Health and Wellness Plan in 2014, which is an expansion plan of the Medicaid program to include adult benefits and more incentives for healthy behaviors. 35 Although, dentists’ participation in the new version did not differ significantly than the older version as cited by a 2019 study, 35 predictors to participation in the two programs varied based on the different structure and administration of the two versions.…”

How Phantom Networks, Provider Qualities, and Poverty Sway Medicaid Dental Care Access: A Geospatial Analysis of Manhattan

“…By the criteria of this study, verified dentists serve either “adults and children” or “adults only”. Additionally, facilities serving only adults were still counted as general providers because access for this population is more limited, as Medicaid dentists may prefer to serve children [ 35 , 37 , 74 ]. Daw [ 16 ] originally defined phantom networks as a group of providers not participating in an insurance plan or no longer accepting new patients under the plan.…”

“…Per our study criteria, dentists working at a single facility less than 20 h per week were likewise classified as eliminated, since they failed to provide at least half-time oral healthcare based on a full-time equivalent (FTE) status of a 40-h work week, thus diminishing their impact on behalf of Medicaid recipients. Moreover, there is no uniform standard for dental work status in the literature; however, most studies, including those of the ADA, have defined full-time equivalent (FTE) status as 32 h or more per week [ 37 , 38 , 40 , 41 , 42 , 53 , 54 , 75 ], and some studies have excluded non-FTE dentists when calculating the supply of providers [ 40 , 42 , 53 , 54 , 75 ]. This study chose a modest half-time work status to allow for the greatest inclusion of available dental care access.…”

“…Several prior studies have examined a few aspects of structural supply elements under the dimension of availability, including the acceptance of new patients [ 34 , 35 , 36 , 37 ], dental provider working status [ 37 , 38 , 39 , 40 , 41 , 42 ], and the age range of groups treated [ 34 , 35 , 36 , 37 , 43 ]. Nevertheless, to the best of our knowledge, no research to date has addressed whether participating dentists limit the range of services for Medicaid patients, and how many providers place caps on the number of publicly insured patients that they are willing to treat during any timeframe.…”