Impact of fee increases on dental utilization rates for children living in Connecticut and enrolled in Medicaid

BackgroundIn 2008, Connecticut’s Medicaid program administration increased children’s dental fees to match approximately the 70th percentile of what the market fees were for dental care in 2005. These Medicaid program changes occurred at the same time as a national economic recession, which took place from 2007 through 2009.MethodsThe authors obtained Medicaid eligibility, claims, and provider data before and after the fee increase, in 2006 and 2009 through 2012, respectively. Their analysis examined changes in utilization rates, service mix, expenditures, and dentists’ participation. The authors qualitatively assessed the general impact of the recession on utilization rate changes.ResultsThe Medicaid fee increase, program improvements, and the recession resulted in a dramatic increase in utilization rates. For children continuously enrolled in Medicaid, utilization rates increased from 45.9% in 2006 to 71.6% in 2012. Rates increased across sex, race, ethnicity, and geographic areas. These increased utilization rates eliminated the disparities in access to dental services between children with private insurance and children receiving Medicaid benefits. Children enrolled in Medicaid now have utilization rates that are similar to or higher than privately insured children. Expenditures increased $62 million; this represents less than 1% of 2012 State Medicaid expenditures. Dentist participation increased by 72%. These results suggest that dentists will participate in the Medicaid program if adequately compensated, and low-income families will seek dental services.ConclusionThe Medicaid fee increase, program improvements, and the recession had a dramatic impact on reducing disparities in children’s access to dental care in Connecticut.Practical ImplicationsOne solution to the substantial disparities in access to dental care is to increase Medicaid fees to competitive levels.