Provision of Oral Preventive Services to Medicaid Eligible Children Younger than Six Years old by Non-Dentists Providers
Creators: name: Arthur, Tania
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2013

description: Background: Oral Health care is the most prevalent unmet health care need for disadvantaged US children; however, lack of access to oral health services continues to be one of the most important factors that contributes to oral disparities. Medicaid programs provide dental coverage for children as part of the Early and Periodic Screening, Diagnostic, and Treatment Program (EPSDT) to reduce the burden of dental disease in children. Goals: The goals of this paper are to describe a new Medicaid initiative designed to increase oral preventive services in children younger than 6 years of age through reimbursement of non-dentist providers; describe the type of non-dentist providers who are involved in its implementation; compare the proportion of children who received dental preventive services by dentists to non-dentists during 2010 and 2011; and discuss the factors that affect the proportion of Medicaid eligible children who receive oral services by non-dentist providers. Methods: A background description of the EPSDT program and the concept of non-dentists providers are presented based on a literature review. Using data from the National and State Annual EPSDT Participation Report (CMS-416), the American Academy of Pediatrics and a published article that presents the year of implementation of preventive initiatives for physicians for all 50 states and the District of Columbia in the USA. A univariate descriptive analysis of the key outcome variable (Proportion of eligible children in the EPSDT program who received any dental preventive service by a non-dentist provider) is presented, and then supplemented by bivariate analyses to examine the associations of several independent variables that represent program characteristics in each state (provider type, number of providers, months since implementation, comprehensiveness of program, and reimbursement level) with rates of service provision per month, stratified by year (2010 and 2011). Results: A large variation in all estimates for use of preventive services was observed by provider type, which includes dental therapists and medical personnel, age and state in both years. During FY 2010 and 2011, nine states (AR, AZ, DE, DC, HI, LA, NH, NJ and OK) had not implemented a policy for the reimbursement of preventive oral services delivered by non-dentist providers. For FY 2010, 27.5% of eligible children received any preventive dental services by a dentist or under a dentist’s supervision, and 4.5% received services by a non-dentist provider. A slight increase was observed for the FY 2011 when 28.9% of children received preventive services by dentists and 5.0% by non-dentists. In both years the percentage of children younger than one year who received preventive services by non-dentists (1.94% in 2010 and 2.39% in 2011) was larger than for dental providers (0.51 % in 2010 and 2011). The number of non-dental providers in each state was the variable that showed the strongest association with the proportion of children receiving services per month but the relationship was not linear or consistent between the two study years. For 2010 the proportion of children receiving services was statistically significant (plt;.05) relative to the difference in number of providers; it was highest for states with one or two non-dental providers delivering preventive dental services (.0046), lowest for states with three or four providers (.0011) and intermediate for states with greater than five providers (.0015). For 2011, the test of significance of differences among categories of non-dentist providers produced a p-value that approached significance (p=.059), but a trend that was quite different from 2010. The highest proportion of children who received preventive services was observed in states allowing three or four non-dental providers (.0013) and five or more providers (.0012), but was lowest, by almost half, for the states with one to two providers (.0007). Conclusions: This paper demonstrates the contribution of non-dentists to providing greater access to preventive service among Medicaid children less than 6 years of age. While programs in states that allow non-dental providers to deliver preventive dental services are having an effect on access to care, particularly among very young children in a few states, overall access is still limited. These findings are a first step and invite further research to measure the full impact of these initiatives on access to preventive dental care among young children in the United States. Further analysis with a more complete set of predictor variables and adjustment for possible confounding among independent variables is necessary to better understand trends and associations in the delivery of preventive dental services by non-dental providers and how they compare to dental providers.