The Role of Medicaid in Children’s Access to Dental Care

— This blog post is an excerpt from the Benevis Whitepaper “The Dental Divide and the Health Chasm It Creates for Too Many Children“ —

An estimated 74 million Americans—nearly a quarter of the population—have no dental insurance coverage. For comparison, that is well over double the estimated 28 million Americans who have no health insurance.*

For low-income families who are least likely to have dental coverage, the cost of dental care can be a major deterrent. They may avoid or delay seeking care for themselves and their children because they cannot afford to pay for it. Joint federal-state programs help to bridge the gap for many families.

About 40% of children between the ages of 2-18 have dental benefits through Medicaid or the Children’s Health Insurance Program (CHIP). These phenomena result in significant deficiencies in access to care.

Broad Disparities in Medicaid Payments

Medicaid reimbursement rates for pediatric dental care vary significantly in different states nationwide:

Low = 27.8% of private insurance reimbursement rates in Minnesota

High = 90.5% of private insurance reimbursement rates in Nevada

National Average = 61% of private insurance reimbursement rates

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SOURCE

American Dental Association: Reimbursement Rates for Child and Adult Dental Services in Medicaid by State infographic. ADA Health Policy Institute, October 2021

While greater coverage is a positive, the reimbursement rates for dentists are low for these programs. Rates vary widely state by state. On a national average, Medicaid and CHIP programs pay just 61% of rates paid by private insurers for child dental health services. As a result, only 39% of U.S. dentists accept Medicaid or CHIP.***

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SOURCES
*U.S. Census Bureau: Health Insurance Coverage in the United States: 2020.” Sept. 14, 2021.

**American Dental Association: Reimbursement Rates for Child and Adult Dental Services in Medicaid by State infographic. ADA Health Policy Institute, October 2021.
***The Center for Health Care Strategies, Inc.: “Medicaid Adult Dental Benefits: An Overview.” September 2019.