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JADA Continuing Education

Increasing Access to Oral Health Care for Families and Children With Low Incomes

Background. Medicaid beneficiaries have lower rates of dental visits and higher rates of dental disease compared with the rest of the population. Beneficiaries ascribe their low use of services to difficulties finding dentists who treat patients with Medicaid. Dentists cite low reimbursement rates, excessive paperwork, and patients’ not keeping appointments and poor oral health literacy as reasons for not accepting patients with Medicaid. The authors pilot-tested the effectiveness of a dental case management program (DCMP) in increasing dentists’ participation in Medicaid and Medicaid beneficiaries’ use of services.

Methods. A dental case manager recruits dentists to participate in the Medicaid program, arranges training in billing procedures, resolves billing and payment problems, educates clients about the use of dental services and keeping appointments, links clients to dental offices, identifies potential barriers to care and helps clients obtain transportation to appointments. The authors evaluated the levels of participation of dentists in the DCMP in Medicaid and Medicaid beneficiaries’ use of services.

Results. Dentists accepting new Medicaid patients increased from two to 28, with 145 dental visits a month provided to Medicaid beneficiaries. The percentage of Medicaid beneficiaries receiving dental services increased from 9 to 41 percent after the DCMP was implemented.

Conclusions. The authors found that the DCMP was effective in increasing Medicaid beneficiaries’ use of services, increasing dentists’ participation in Medicaid, minimizing administrative burdens related to Medicaid participation, and increasing oral health literacy and treatment compliance among clients with low incomes.

Key Words: Access to care; social support; Medicaid; dental care utilization; office visits; public health and community dentistry; vulnerable populations; patient education

Abbreviations: ADA: American Dental Association • DCMP: Dental case management program • EPSDT: Early and Periodic Screening, Diagnostic, and Treatment • GAO: U.S. General Accounting Office • NYC: New York City • NYS: New York state • ROS: Rest of state • SCHIP: State Children’s Health Insurance Program