Determining dental utilization rates for children: an analysis of data from the Iowa Medicaid and SCHIP programs.

OBJECTIVE: Accessing dental care is a significant problem for children in Medicaid and SCHIP. Evaluating the extent of the access problem is affected by the differential dental utilization rates as calculated by unique approaches used by national organizations. The problem is related to the intermittent enrollment in Medicaid and SCHIP for many children during the year. The objective of this study is to evaluate the effect of four different approaches for calculating dental utilization rates for children in Medicaid and SCHIP programs. METHODS: All Iowa Medicaid and S-SCHIP dental claims and enrollment files for CY 2001 were used to characterize the populations, calculate dental utilization rates and evaluate the types of services received by dental utilizers. Dental utilization rates were calculated four ways using the following different rate denominators: 1) any child enrolled during the year (Center for Medicare and Medicaid Services method), 2) children enrolled for 11-12 months (National Committee for Quality Assurance method), 3) a full-time equivalents (FTE) method, 4) only newly enrolled children. RESULTS: The methodology employed greatly affected the dental utilization rates. Rates varied from 18% for newly enrolled children in Medicaid to 58% for S-SCHIP-enrolled children using the FTE method. Methods that included children who were more likely to be in for more months during the year, such as the NCQA approach, produced the highest rates. CONCLUSIONS: The method used to determine the dental utilization rates for Medicaid and SCHIP enrollees should be clearly stated when these rates are being presented. This will allow the reader to be able to make a careful and appropriate interpretation of the results.