Pennsylvania Medical Assistance : Evaluation of Children ’ s Access to Dental Services
• Periodontal services for children who qualify
• Radiographs / diagnostic imaging
Dental Expenditures for Children
In 2008 , Medical Assistance spent about $ 124.9 million on dental services for children , or approximately $ 109 per enrolled child . 10 There was considerable variation in expenditures across the counties in Pennsylvania . The expenditures ranged from $ 72 per child in Tioga County to $ 223 in Fayette County . 11
These expenditures are low relative to the national average for all children , which we estimate was about $ 284 in 2008 . 12 Pennsylvania dental expenditures are relatively low in part because Medical Assistance dental fees are low . The Pew Center on the States reported that Pennsylvania ’ s Medical Assistance reimbursement rates were 53.2 percent of dentists ’ median retail fees in 2008 . 13
Access to and Quality of Dental Care for Children in Medical Assistance
Access to Care
The Pennsylvania Department of Public Welfare ( DPW ) provided us with the most recent data on annual dental visits for children who are enrolled in ACCESS Plus ( FFS Medical Assistance ). Table 2 shows that among all children and within each age group , the proportion of children with an annual dental visit increased from 2006 through 2009 . 14 In 2006 , only 38.72 percent of children had an annual dental visit , while over 55 percent of children did in 2009 . 15
Table 2 : Proportion of Medical Assistance Children in FFS Age 4 to 21 with an Annual Dental Visit from 2006 through 2009
2-3 years 4-6 years 7-10 years 11-14 years 15-18 years 19-21 years Total
Source : Department of Public Welfare Data
2006 |
2007 |
2008 |
2009 |
13.39 % |
19.58 % |
22.25 % |
23.95 % |
44.51 % |
50.89 % |
58.68 % |
59.91 % |
47.95 % |
51.97 % |
59.56 % |
60.80 % |
44.22 % |
47.54 % |
53.11 % |
55.50 % |
40.32 % |
43.25 % |
48.01 % |
50.21 % |
27.45 % |
28.39 % |
35.21 % |
38.49 % |
38.72 % |
42.68 % |
48.90 % |
50.59 % |
DPW requires Medical Assistance managed care organizations ( MCOs ) to report on two performance measures related to access to dental care : ( 1 ) the proportion of children aged 3 to 20 who had an annual visit and ( 2 ) the proportion of enrollees age 4 to 21 with developmental disabilities who had an annual dentist visit .
Figure 2 shows the proportion of children ages 3 to 20 enrolled in a Medical Assistance MCO who had an annual dental visit from 2005 through 2009 . 16 While in 2009 , less than half of the children enrolled in Medical Assistance had an annual dental visit ( 42.8 percent ), this proportion has been increasing over time . There is considerable variation across the plans . In 2009 , the proportion of children who had an annual dentist visit ranged from 37.6 percent at AmeriHealth to 45 percent at Health Partners .
Figure 2 : Proportion of Medical Assistance Children in Managed Care Age 4 to 21 with an Annual Dental Visit from 2005 through 2009
Source : Office of Medical Assistance Programs , Division of Quality Assessment . HealthChoices Performance Trending Reports for 2007 and 2009 . http :// www . dpw . state . pa . us / Resources / Documents / Pdf / AnnualReports / 2009HealthChoicesPerfTrendingReport . pdf and http :// www . dpw . state . pa . us / Resources / Documents / Pdf / AnnualReports / 20 07HealthChoicesTrendRpt . pdf
Figure 3 shows the proportion of Medical Assistance MCO enrollees with developmental disabilities who had an annual dental visit from 2005 through 2009 . Overall , 44 percent of these enrollees had an annual visit in 2009 . Between 2008 and 2009 , there was a slight improvement in performance of all plans with the exception of AmeriHealth . Again , there is wide variation in each plan ’ s performance . In 2009 , the proportion of children with developmental disabilities that had an annual dental visit ranged from 33.4 percent in AmeriHealth to 53 percent in Health Partners .
September / October 2010 • Pennsylvania Dental Journal
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