Health Care Workforce

Access to dental care in the U.S. is a severe problem for young children, underscored by the fact that only a quarter of all children under six had a dental visit in 2004. In an effort to address these access issues, many states have begun reimbursing medical providers for delivering basic oral health services to children. This issue brief provides an update to the 2008 State Health Policy Monitor, The Role of Physicians in Children’s Oral Health, which highlighted state efforts to increase access to preventive dental care through the use of medical providers. Currently, 34 state Medicaid programs reimburse primary care providers for performing preventive oral health care services on children, including nine new state programs since last year’s study. These preventive oral health care services include the application of fluoride varnish, anticipatory guidance/caregiver education, risk assessment, and an oral examination/screening.

Access to dental care is an increasingly serious problem for many people in the United States, particularly for children.  There is a shortage of private dentists and a limited availability of affordable, or government-supported dental care. This is further compounded by the small number of private dentists willing to participate in public health insurance programs, or treat young children and other underserved populations, especially in rural areas. 

In the drive by many states to craft programs to expand health coverage to reach more, if not all, of their uninsured population, the focus has been on the cornerstone implementation issues of mandates and affordability. Less attention has been paid to the question of whether there is adequate provider capacity to deliver care, especially to those who could gain coverage under state health reform. The National Academy for State Health Policy (NASHP), under a National Cooperative Agreement with the Health Resources and Services Administration (HRSA), Bureau of Primary Health Care (BPHC) is working to better inform state policy makers on how actions to expand coverage may affect the health care safety net, and particularly federally funded community health centers. This State Health Policy Briefing is intended to stimulate dialogue and promote collaboration between state government and safety net providers in addressing shared missions and goals for assuring access to care for vulnerable populations.

Dentists cite three primary reasons for their low participation in state Medicaid programs: low reimbursement rates, burdensome administrative requirements, and problematic patient behaviors. In the late 1990s and early 2000s, a number of states took dramatic steps to try to improve access to dental care in Medicaid. Alabama, Michigan, South Carolina, Tennessee, Virginia, and Washington employed a variety of approaches to address access concerns. They raised reimbursement rates, revamped administrative structures and processes, and conducted outreach and education to both providers and patients. This study, sponsored by the California HealthCare Foundation, focuses on the efforts of these six states and compares their experiences to California’s. The National Academy for State Health Policy (NASHP) conducted a literature review and 26 key informant interviews to answer the question: what effect does raising Medicaid reimbursement rates have on access to dental care?