Assessing Timely Access to Dental Care Services: A Review of the Impact of Michigan's Medicaid Dental Care Policy on Child Abuse and Neglect Wards

Background & Purpose:  Foster care youth face great oral health disparities, yet very little research has examined  oral health and access to dental care among this population. One cross-sectional study found that only 43% of foster children in the state of Washington during a 12 month period had received any kind of dental care (Melbye, Chi, Milgrom, Huebner, & Grembowski, 2013).  Virtually all foster children depend on Medicaid to finance their dental care.  As a cost cutting measure in 2010, Michigan changed the financing structure of Medicaid health care services for court wards from fee for service (FFS) to a managed care system (HMO); however, dental care services have remained under the fee for service system.  This study will examine the timeliness of comprehensive dental examinations, which are mandated by the State’s child welfare policy to be completed within 90 days of initial foster care entry.

 Methods: This longitudinal cohort study used linked administrative data provided by the State’s Departments of Human Services and the Community Health, Medicaid data warehouse collected between 2009 and 2012. Data was analyzed with SPSS using descriptive and multivariate statistics. 2468 foster care youth (58% females and 42% males; 56% white, 36% African American, and 8% other) between the ages of 14 and 20 years met the criteria for inclusion in this study. The median number of placements in the sample was 2.

 Results:Only 32% of the youth in the model obtained a dental visit within 90 days of foster care entry.  Children who entered care during the implementation of the Medicaid HMO policy period had lower odds of having their dental visit with 90 days of foster care entry than those who entered under the FFS period (OR=.6, CI .5-.8). Older youth (16+) had higher odds of receiving a timely dental exam (OR= 3.1, CI 2.3-4.2) and those with 2 or more placements had lower odds of receiving a timely visit than those with only 1 placement (OR= .2, CI .15-.24).  There were no statistical differences observed by race or gender.

 Conclusions & Implications: Foster youth have significant health needs, with many continuing to have irregular access to routine dental health care services.  Implications for policy and practice include the need to ensure comprehensive evaluation, routine dental care, & timely follow up.  There is also a need to create cross-system data systems that preserve and track dental health information for foster care youth and to increase Medicaid reimbursement rates for dentists.