Children's Access to Dental Care Affected by Reimbursement Rates, Dentist Density, and Dentist Participation in Medicaid.

OBJECTIVES: To assess the relation between Medicaid reimbursement rates and access to dental care services in the context of dentist density and dentist participation in Medicaid in each state. METHODS: Data were from Early and Periodic Screening, Diagnostic, and Treatment reports for 2014, Medicaid reimbursement rate in 2013, dentist density in 2014, and dentist participation in Medicaid in 2014. We assessed patterns of mediation or moderation. RESULTS: Reimbursement rates and access to dental care were directly related at the state level, but no evidence indicated that higher reimbursement rates resulted in overuse of dental services for those who had access. The relation between reimbursement rates and access to care was moderated by dentist density and dentist participation in Medicaid. We estimate that more than 1.8 million additional children would have had access to dental care if reimbursement rates were higher in states with low rates. CONCLUSIONS: Children who access the dental care system receive care, but reimbursement may significantly affect access. States with low dentist density and low dentist participation in Medicaid may be able to improve access to dental services significantly by increasing reimbursement rates.

Expansion of dental benefits under the Medicare Advantage program.

Uninsured older adults are twice as likely to not receive needed dental care as their insured counterparts. Yet, nearly one-third of older adults have untreated dental caries, and older adults are more likely to have complete tooth loss, periodontal disease, and oral cancer. Moreover, persons sixty-five and older had the lowest percentage of individuals with dental insurance and the highest average out-of-pocket expenses of all persons with a dental visit in 2000. Given that retiree health benefits for large companies have declined from 66 percent in 1988 to 38 percent in 2003, it is unlikely that the private sector will increase funding for dental benefits for the elderly. However, some Medicare managed care plans already cover either preventive or comprehensive dental benefits. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 created incentives for Medicare managed care plans to offer beneficiaries additional benefits, including dental. The First Seniority Dental Plan, described in this article, demonstrates that it is possible to create a dental plan that is affordable for the HMO, reimburses providers at reasonable rates, provides a reduction in costs to Medicare beneficiaries, and may present a method to expand dental benefits for elders of the future.