Sometimes even the best national data available are still insufficient to draw meaningful policy conclusions. On May 31, the American Dental Association’s Health Policy Institute released a 50-state report estimating the geographic proximity of publicly insured children to Medicaid providers. The report uses sophisticated geomapping to match a national database of publicly insured children to state-based lists of dentists enrolled in Medicaid. However, the report’s methodology for determining this is flawed and probably overestimates dentist participation in Medicaid in most states.
Here’s why: The report relies on Insure Kids Now—a national website with state-submitted data that lists dentists who registered for Medicaid and the Children’s Health Insurance Program (CHIP)— to tally dentist participation in Medicaid. But the survey informing this count asks only whether dentists are enrolled in the program, not how many children they served, or whether they served any at all. Medicaid experts acknowledge that in many states, the number of dentists serving meaningful numbers of publicly insured patients, or taking on new Medicaid patients, is much lower than the Insure Kids Now list would suggest.
Take Iowa, for example. According to the state’s Insure Kids Now list, Medicaid dentist participation was 86 percent in 2014. But a survey conducted by the University of Iowa the previous year found that only 16 percent of private practice dentists accepted all new Medicaid patients, 42 percent placed conditions on accepting new Medicaid patients, and 42 percent would not see any new Medicaid patients.Yet using the Insure Kids Now list and geomapping, ADA’s latest report states that 93 percent of publicly insured children live within 15 minutes of a Medicaid dentist in Iowa.
In Florida, the Insure Kids Now database finds that 30 percent of dentists were enrolled in Medicaid or CHIP in 2014. But a 2013-14 survey of dentists conducted by the state Health Department found that less than 23 percent reported treating any Medicaid patients, and only 15 percent reported taking new ones. Finally, only 10 percent reported treating at least 125 Medicaid patients. Because a typical dental practice serves 1,500 patients, these numbers indicate that most dentists in Florida were seeing very few Medicaid patients. Meanwhile, in 2014, nearly 70 percent of Florida children on Medicaid went without a dental visit. Still, ADA’s latest report finds that 96 percent of publicly insured children in the state live within 15 minutes of a Medicaid dentist.
Millions of Americans do not have access to oral health care. Although a dentist may have an office within 15 minutes of a patient on Medicaid or CHIP, that dentist might choose not to treat that patient. More surveys such as the one conducted by the University of Iowa—which asks dentists about volume of care provided and whether they treat adults, accept new Medicaid patients, and place any limits or conditions on them—should be conducted to determine the true level of access that Medicaid patients have to dental care.
Jane Koppelman directs research for The Pew Charitable Trusts’ dental campaign.