North Carolina Physician-Based Preventive Oral Health Services Improve Access And Use Among Young Medicaid Enrollees

Abstract

To combat disparities in oral health and access to dental care among infants and toddlers, most state Medicaid programs now reimburse physician-based preventive oral health services, such as fluoride varnish applications. We used geospatial data to examine the distribution of dental and medical Medicaid providers of pediatric oral health services throughout North Carolina to determine if these services have improved access to care for Medicaid enrollees younger than three years old. We then used claims data to examine the association between distance from these practices and use of dental services for a cohort of approximately 1,000 young children. Among 100 counties, four counties had no physician-based preventive oral health services and nine counties had no dental practice. While children who lived further from the nearest dental practice were less likely to make dental visits, distance from physician-based preventive oral health services did not predict use. For young Medicaid enrollees, oral health services provided in medical offices can improve access and increase use.

Travel burden and dentist bypass among dentally insured children

“…Previous research has included distance to the nearest dentist as a measure of workforce accessibility . However, our finding that nearly 77 percent of children with a dental visit bypassed the nearest provider indicates that this measure may not adequately describe local potential access to dental care.…”

Delivery of Preventive Oral Health Services by Rurality: A Cross‐Sectional Analysis

“…These include having less access to dentists, which is exacerbated because many general dentists are reluctant to treat young children . With few pediatric dentists practicing in rural areas, children in rural areas often have to travel far for a dental visit . An additional challenge to obtaining dental care for children living in rural areas, who are more likely to live in poverty and have public insurance compared to children living in urban areas, is the reluctance of many dentists to accept Medicaid …”

Changes in pediatric dental coverage and visits following the implementation of the affordable care act

“…Although the ACA aims to make pediatric dental coverage more available, it does little to address other barriers to dental care. Many factors affect children's receipt of dental care beyond dental coverage, including cost, distance to care, and parents’ prioritization of oral health . For example, in 2014, the maximum out of pocket cost on stand‐alone pediatric dental plans was $700 for a single child, which decreased to $350 in 2015 .…”