Assessing the Utilization of Preventive Dental Services Among Children Enrolled in Medicaid within Allegheny County

BACKGROUND:  Dental disease is the most common chronic disease among U.S. children despite its potential for prevention. In 2015, the Allegheny County Health Department completed a Community Health Assessment with input from diverse stakeholders in which access to dental care was identified as a health priority. Subsequently, a Dental Task Force, comprised of managed care organizations (MCOs), providers, nonprofit organizations, the ACHD dental program and University of Pittsburgh, was formed. Their goal was to assess reasons for low rates of preventive dental care, particularly among the high-risk population of Medicaid children. The aims of our study were to 1)identify the number of children enrolled in Medicaid who had received preventive dental services; 2) determine the relationship of getting preventive care to race, gender, age and geography.

METHODS:  The study population was defined as Allegheny County residents, ages 1-20 years (+364 days) at time of enrollment who were effectively enrolled in Medicaid for at least 90 continuous days during the 2014 calendar year. MCOs provided dental claims data for preventive care, defined by a subset of procedure codes between D1110 and D1999. Children meeting the inclusion criteria were considered to have received preventive dental services if they had at least one of these procedures during the year. A merged dataset of Allegheny County’s MCO data was used to calculate the prevalence of children utilizing preventive services, stratified by age, gender, and race. ArcGIS mapping was used, in combination with population data from the 2010-2014 American Community Survey, to identify geographic disparities in preventive dental care.

RESULTS:  The proportion of children in Medicaid receiving preventive dental care did not differ substantially by race [White: 41%, Black: 42%, other: 42%, unknown: 35%] or gender [male: 40%, female: 44%]. However, the proportion receiving preventive care varied markedly according to age [range: 4%-56%]. The lowest proportions were observed among children < 5 years [25%] and 17-20 years [31%]. Using geospatial analyses, we observed several areas within the county with disproportionately low utilization.

CONCLUSIONS:  Preventive dental care utilization differed considerably according to geography and age. Given the importance of early dental care in the prevention of chronic dental disease, the task force recommends that future interventions be tailored to low-income children less than 5 years in areas with the lowest utilization rates. Further research regarding the barriers to receiving preventive care in this population is needed.