JADA, Vol. 129, June 1998 753
Approximately one-fourth of the children in
Washington state are
eligible for Medicaid dental services.
This includes the children in
the traditional low-income population, as
well as the children of the
working poor covered by Medicaid through
Washington state’s
Basic Health Plan. Children in families
having incomes of up to 200
percent of the federal poverty levels are
eligible. In theory, dental
treatment benefits should be extended to
more than half a million
children in Washington state who will
benefit from it the most.
According to recommendations from the
American Academy of
Pediatric Dentistry, all children should
have at least biannual dental
visits.1 Nevertheless,
only 28 percent of children from birth to 17
years of age made at least one visit to
the dentist in 1996. Thus,
utilization rates for Medicaid children’s
dental services are particularly
low. The utilization rates are similar in
most other states.2
Nominally, two-thirds of Washington
states’ active dentists serve
the Medicaid-insured population; 25
percent of the dentists, however,
care for 89 percent of the children who
are seen (Carree Moore,
Dental Program Manager, Department of
Social and Health
Services Medical Assistance
Administration, personal communication,
1998). This disparity is a key factor in
the limited access to
dental services for children from low-income
families. In addition,
the number of dentists in some rural
counties, in which a large
number of Medicaid-eligible children may
live, ranges from zero to
four, thus further exacerbating the access
problem.3
In the areas with large supplies of dentists,
the reasons that
more dentists do not see Medicaid clients
are complex. The typical
reasons dentists gave for their personal
lack of participation were
that the reimbursement fee levels are low,
payment is not timely
and the system is bureaucratic, and the
population is difficult to
work with; they are no-shows, cancel
appointments or do not comply
with care instructions.4-7
The law mandates the provision of certain
preventive services for
Medicaid-eligible children. The federal
Early Periodic Screening,
Diagnostic and Treatment, or EPSDT,
program enacted in 1967 requires
that under the Medicaid program all states
make provisions
for preventive dental services to
children. The states’ two primary
SURVEY OF MEDICAID CHILD
DENTAL
SERVICES IN WASHINGTON
STATE:
PREPARATION FOR A
MARKETING PROGRAM
PETER MILGROM, D.D.S.;
CHRISTINE RIEDY, PH.D.
The authors
surveyed Washington
state
dentists to gain an understanding
of their
participation in
the Medicaid
dental program,
their
willingness to learn more
about the
program and the degree
of importance
they attached
to preventive
care for preschoolaged
children.
They found that
concerns
about fees and administrative
aspects
predominated and
concerns
about client behaviors
were
expressed less often. Many
dentists
indicated a willingness to
learn more
about the program.
These
findings will be used to develop
a plan to
market the
Medicaid
program to Washington
state
dentists.
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