PHILADELPHIA — Less than 40 percent of children who are insured via Medicaid/Children's Health Insurance Programs are able to obtain care for a dental emergency, compared to 95 percent of those with private insurance, according to new research from the Perelman School of Medicine at the University of Pennsylvania published online this week in the journal Pediatrics. Even among dental providers who were participants in the state Medicaid/CHIP program, nearly a third studied denied appointment access to children with that type of coverage — unless parents offered to pay in cash.
In the study, research assistants posing as mothers of a 10-year-old boy with a fractured permanent front tooth — an injury that impacts 1 in 7 children ages 8 and 13 and 25 percent of adolescents in the United States — made calls seeking an urgent appointment with a random sample of 85 Cook County, Ill., dental practices, 41 of which were signed up to participate in the Medicaid program. The researchers called each practice twice, approximately four weeks apart, varying only their purported insurance status but maintaining all other aspects of their scripted story. Overall, callers were told their insurance type was not accepted by the non-enrolled dental practices in 93 percent of calls from Medicaid/CHIP patients' mothers, compared to only 9 percent who said they had Blue Cross insurance.
"Although our study shows significant barriers to emergency dental care based on insurance status, more than two thirds of practices who participate in Medicaid/CHIP did offer appointments when plan participants sought them, and 75 percent of them offered a slot for those children within two days of the call," says senior author Karin V. Rhodes, MD, MS, director of Emergency Care Policy Research in the department of Emergency Medicine at Penn. "However, the law calls for these programs to provide equal access to care, and our results show that many children in need are still being turned away when they need help — unless their parents are able to pay out of pocket."
Thirty-four percent of callers were asked for their child's insurance type before being told whether or not they could schedule an appointment. When operators did not ask about insurance status before scheduling, the callers inquired about whether their coverage was accepted. After insurance status was revealed, access to care was often rescinded: 7 percent of appointments for publicly-insured children were canceled by practices enrolled in the program, and 41 percent by nonenrolled practices — when they found out the child was insured by Medicaid/CHIP, despite a provision in the state Medicaid program that reimburses providers for all emergency dental care. None of the scheduled appointments for Blue Cross patients were retracted based on insurance status.
Rhodes notes that her own daughter, at age 13, suffered the same dental injury as the one tested in this experimental study design. "The injury was not only a dental emergency, it required ongoing dental care for years to come," she says. "The question is, do we as a society want to provide quality dental care for all of our children or just the ones whose parents can afford to pay?"