Impact of South Carolina's Medicaid fluoride varnish reimbursement policy on children's receipt of fluoride varnish in medical and dental settings.

OBJECTIVE: We estimated the effect of South Carolina's (SC) Medicaid fluoride varnish (FV) reimbursement policy on children's receipt of fluoride varnish in medical (MFV) and dental (DFV) settings. METHODS: We obtained data from SC Medicaid enrollment and claims files for children ≤ 47 months of age across State Fiscal Years (SFY) 2008-2013 and created a panel dataset of 52,841 children representing 126,464 child-years of observation. Pooled multivariate logistic regression models were estimated to identify factors associated with a higher likelihood of a child receiving one or more MFV or DFV treatments. RESULTS: The FV rates per child-year were 1 percent for physicians and 23 percent for dentists, respectively. The child-year rate for receipt of FV from both a physician and a dentist was less than one-third of one percent. CONCLUSIONS: A policy designed to increase access to FV treatments from physicians and dentists for children up to forty-seven months of age was not successful for physicians; however, the positive findings for dentists were promising.

Differences in dental service utilization by rural children with and without participation in Head Start.

PURPOSE: The purpose of this study was to assess differences in dental and medical care utilization for dental problems between rural Head Start (HS) participants and a nonexposed group. METHODS: A matched retrospective cohort study was conducted using chi-square, Poisson, and logistic regression models. We linked Medicaid claims and HS enrollment data for 7 rural counties in South Carolina to examine oral health service utilization in dental, primary care (PC), and emergency room (ER) settings. The exposed group included 985 HS participants during the 2007/2008 school year and the nonexposed group included 1,969 children enrolled in Medicaid but not HS. RESULTS: HS participants were more than twice as likely to visit dentists for preventive, diagnostic, and restorative care (P<.001). The odds ratio of HS participants relative to the nonexposed group for PC visits for oral health problems was 1.94 (P=.03). No differences between HS participants and the nonexposed group for oral health-related ER visits were observed (P=0.33). CONCLUSIONS: Head Start participants accessed dental care with greater frequency than the nonexposed group. Findings provide evidence that Head Start grantees positively impact dental service utilization for their children. Future research should examine the programmatic features to which the outcomes can be attributed and whether utilization trends continue after Head Start completion.

Rural-urban differences in dental service utilization among an early childhood population enrolled in South Carolina Medicaid.

Our exploratory study examined rural-urban differences in dental care utilization during early childhood among Medicaid-enrolled children aged younger than 4 years in South Carolina. We conducted a secondary data analysis using Medicaid data. Dependent variables included preventive dental visits, use of medical settings (emergency room [ER] and primary care [PC] offices) for dental reasons, receipt of fluoride varnish, and dental home status. The primary independent variable was child's area of residence, rural or urban. The control variables were child's age, gender, race, and special healthcare need status. In adjusted analyses, rural children were found to have significantly higher odds of lacking preventive dental visits, fluoride varnishes, and dental homes as well as using medical settings for dental reasons compared to urban children. This difference, however, was not a simple function of rural residence. Other variables such as race and special healthcare need status interacted with rurality in explaining the differences in the outcomes of interest except visiting medical settings for dental reasons. Children under age of 2 years had higher odds of undesirable outcomes compared to those aged older than 2 years. Significant disparities in dental care utilization were evident among rural, Medicaid-enrolled preschool-aged children in South Carolina. While the state has addressed Medicaid reimbursement and related policies for nearly 10 years, their impact may be disproportionately effective.