GAO: Dental Care Access Limited in Low-Income Children

Emma Hitt, PhD
December 2, 2010 — Access to dental care poses a significant challenge for children in Medicaid and the Children's Health Insurance Program (CHIP), despite ongoing efforts to connect patients' families with dental providers, according to the US Government Accountability Office (GAO).
Under the directive of the CHIP Reauthorization Act of 2009, the GAO presented an overview of dental care access among children who are served by CHIP and Medicaid in a congressional report released this week.
In 2000, the Surgeon General reported that tooth decay was the most common chronic childhood disease and described a "silent epidemic of oral disease affecting the nation's poor children." According to the new report, high rates of dental disease in children in low-income families and the "challenge of finding dentists to treat them are long-standing concerns."
To determine the current level of dental access for low-income children, the GAO assessed state-reported dentist participation in Medicaid, CHIP, and the Department of Health and Human Services' (HHS's) Insure Kids Now Web site for all 50 states and the District of Columbia. They also reviewed data on access for children served by Medicaid and CHIP throughout the United States and in managed care and examined federal efforts to connect families with participating dentists.
"Providing complete and accurate information to help families...find dental care is an important tool in improving access," the report stated. The GAO noted some difficulties with finding comprehensive and reliable information about dental providers for children served by Medicaid and CHIP. For example, HHS's Insure Kids Now Web site, a tool designed to match children enrolled in Medicaid and CHIP with dentists who can serve them, contains some inaccurate and incomplete information about dentists, including wrong or disconnected telephone numbers.
In addition, the report states that less than 37% of children in Medicaid received dental services in 2008. Although this figure has improved since 2001, it is still far below HHS's Healthy People 2010 target of 66% for low-income children, which is likely a result of a combination of low participation by dentists in Medicaid and CHIP and a lack of information about dental providers.
The GAO noted that HHS's Health Center and National Health Service Corps programs, which serve both children and adults, reported increases in the number of dentists and dental hygienists practicing in underserved communities but also emphasized the continued need for dental providers to treat low-income individuals.
The GAO also interviewed officials from 4 countries and 8 states and found that in addition to dentists, midlevel dental providers, who can perform intermediate restorative services under remote supervision of a dentist, are in limited use in the United States and may help improve children's access to dental care.
In addition, the GAO recommended several steps to improve dental care access for children covered by Medicaid and CHIP. They suggested a periodic verification of dental providers' information on HHS's Insure Kids Web site, as well as a provision for alternate sources of information during Web site maintenance. They also recommended that the Administrator of the Centers for Medicare & Medicaid Services should ensure the collection of comprehensive and reliable data on Medicaid and CHIP dental services by managed care programs in different states.
HHS agreed with the recommendations and noted specific actions it will take.


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