Factors Affecting Iowa Dentist Participation in Medicaid

McKernan, S.C.; Reynolds, J.C.; Kuthy, R.A.; Kateeb, E.T.; Adrianse, N.B.; Damiano, P.C.
12/2013

Abstract

The Medicaid program provides public health insurance for low-income children and adults; eligibility criteria for adults varies by state and is expressed as a

percentage of the federal poverty level. In 2011, 431,000 Iowans were enrolled in Medicaid; approximately half of these individuals were children, one-quarter were adults, and one-quarter were either elderly or disabled.

Each state is required to provide Medicaid-enrolled children with comprehensive dental benefits through the federally mandated Early and Periodic Screening,

Diagnosis, and Treatment (EPSDT) program. Through the EPSDT program, all medically necessary dental services are covered free of charge to Medicaid-enrolled

children. A significant proportion of children in Iowa are insured through Medicaid: 18% of Iowa’s children get their dental coverage through Medicaid.

Unlike children, states are not required to provide comprehensive dental coverage for Medicaid-enrolled adults. In 2007, six states offered no adult Medicaid dental benefits and 16 states provided coverage for dental emergencies only. However, Iowa provides a relatively comprehensive set of dental services for adult enrollees.

The oral health safety net includes: 1) private dentists who provide care to Medicaid enrollees and 2) publicly supported communiity health centers. In Iowa there are only 12 federally qualified health centers (FQHCs) and two“look-a- like” clinics so the participation of private practitioners in the Medicaid program is critically important for the access of publicly insured populations,. To better understand the capacity for Medicaid enrollee to receive dental care from private practitioners, a survey was conducted with all private dentists in Iowa to determine their level of participation in Medicaid and their attitudes toward the program and treating underserved populations.

Citation

McKernan SC, Reynolds JC, Kuthy RA, Kateeb ET, Adrianse NB, Damiano PC. Factors Affecting Iowa Dentist Participation in Medicaid. Iowa City, IA: University of Iowa Public Policy Center; 2013.