Hispanic children from low-income families have the highest use rate for dental services – 76 percent – in the state’s HUSKY A (Medicaid) program in 2012. That was greater than the rates for African-American children (70 percent) and Caucasian children (72 percent).
That data is part of a report called “Something to Smile About: Successfully Reducing Dental Access Disparities,” issued by the Connecticut Health Foundation. It shows that the percentage of children continuously enrolled in Medicaid who visited a dentist at least once each year increased from 45.9 percent in 2006 to 71.6 percent in 2012.
“Connecticut has been a leader and in the forefront of ensuring that its children, especially under-served children, have access to dental health services,” the report said.
The study’s co-authors, Tryfon Beazoglou, professor emeritus, and Dr. Joanna Douglass, associate professor, both at UConn’s School of Dental Medicine, attribute the improvement to changes implemented in 2008, when the state increased reimbursement rates to about 70 percent of average fees dentists charged to privately insured children in 2005, and simplified the administration of the program. The previous rates had been set in 1993.
“Low-income children are much more likely to suffer oral health disease, but are also much less likely to obtain dental care,” their report noted. Historically, in Connecticut, a significant barrier to care has been low private dentist participation in Medicaid, which many providers attributed to low reimbursement rates and cumbersome program administration.
From 2009 to 2012, more children used dental services every year regardless of age, gender, race or ethnicity. Out of the state’s 169 cities and towns, 152 had dental utilization rates of 60 percent or higher in 2012, as opposed to four municipalities in 1999.
On the provider side, the number of dentists participating in the Medicaid program increased from 595 in 2006 to 1,230 in 2012.
Connecticut’s 2012 dental utilization rate for Medicaid children was even higher than the averages for privately insured children, which were 65 percent nationally and 68 percent in the state.
According to Beazoglou, “this rate is probably the highest in the country.”
Because of the changes, expenditures increased by about $62 million, from $18.2 million in 2006 to $80.7 million in 2012. That increase was less than 1 percent of the state’s 2012 Medicaid expenditures, he said.
Countering the critics
Writing in the January issue of the Journal of the American Dental Association, Beazoglou, Douglass, Veronica Myne-Joslin, Patricia Baker and Dr. Howard Ballit, said the findings refute two commonly-voiced arguments against the value of increasing reimbursement rates.
One was that, “somehow, minorities do not appreciate the value of good oral health. Another argument was ‘there’s discrimination out there,'” Beazoglou said, meaning that dentists did not want minority children and their families coming to their practices, regardless of the reimbursement rate.
“Both of those allegations don’t have any basis in truth. The parents will take their kids to dentists, and the dentists will provide services. We see that across the board, whether it’s white kids or black kids or Latino kids,” he said.
The economic recession, which hit the state at about the same time that the higher reimbursement rates and administrative streamlining were being implemented, was also a factor. With large numbers of people out of work and others seeing their wealth diminish, “dentists experienced a marked decrease in demand for care and in their incomes,” the authors note in their JADA article.
At the same time, the number of children enrolled in the state’s Medicaid program increased.
As a result, more dentists viewed the Medicaid program positively and were willing to accept Medicaid patients, which helped them make up for the loss of other business. Given the state’s economic circumstances, the fees charged to privately-insured patients were below market fees in 2008 and increased less than 3 percent between 2009 and 2012, while the dental component of the Consumer Price Index rose by 8 percent during the same period. The result was a decline in real market fees.
Still, periodic adjustments in the state’s Medicaid reimbursement rates will be needed so that low-income children can continue to receive dental care at rates comparable to those of their privately-insured peers. Otherwise, “as things pick up, you’re going to see more and more dentists not willing to accept Medicaid kids,” Beazoglou said.
Research can’t explain high rate of Latino participation
As for why Hispanic children had the highest utilization rates among those covered by Medicaid, Beazoglou said he could only speculate, because all of the data for the study came from Medicaid claims. No qualitative information was available as to how patients, parents or dentists viewed the Medicaid program before or after the 2008 changes. Neither was there any information about the impact of increased access on children’s oral health outcomes, the JADA article said.
“Anecdotally, I heard that in the Latino community there is high respect for doctors,” so that parents were looking for dentists for their children, Beazoglou said.
Also, in Hartford, where Hispanics, or Latinos, make up 43.4 percent of the population, according to the 2010 US Census, dental care may be more widely available to low-income families than elsewhere – in schools and community health centers, in addition to dentists’ private offices, “but those services were there before,” he said.
Even before reimbursement rates increased, Hispanics had higher dental utilization rates than other low-income groups. It could be something cultural, Beazoglou said, “but I don’t know.”
For an infographic on this, please visit: http://www.cthealth.org/publication/dental-access-disparities-reduction/