Background: In children 6 to 19 years old dental caries are the most common chronic disease and four times more prevalent than asthma in teens (Centers for Disease Control and Prevention, 2016). Under the ACA, Children's dental services are required for Medicaid and CHIP but in the marketplaces dental coverage is not a required purchase.
Goal: The goal of this project was to understand how recent dental coverage policies impact children accessing dental services through each of the insurance types (Medicaid, CHIP, Private On/Off-Exchange).
Objectives: 1. Is there a difference in utilization rates of pediatric dental services between children accessing benefits via plan types including: Medicaid, CHIP, and private insurance on and off-exchange? 2. Between these plan types is there a difference in the rates of financial barriers to dental services experienced by children? We compare utilization and financial barriers to dental services between children (1-20 years) with dental coverage through Medicaid, CHIP and those with private coverage on and off-exchange using a nationally representative sample.
Approach: We use the National Health Interview Survey (NHIS) (2014-2016) to compare the odds of dental utilization and the odds of experiencing a financial barrier to dental services between children and adolescents aged 1-20 years by insurance type (Medicaid, CHIP, private on-exchange, private off-exchange). Using two logistic regression models we calculated differences between groups controlling for sex, race/ethnicity, household income, and health status and region.
Results: Findings suggest there is a significant difference in use of dental services between kids on Medicaid and exchange-based dental coverage (OR: .58, P: 0.00). Further we find that children in the CHIP program are much more likely to experience a dental visit compared with children on Medicaid (OR: 1.69, P: 0.00). Compared with the Medicaid cohort, children with private dental coverage off-exchange are less likely to experience a financial barrier (OR: .75, P: 0.00) and children with private insurance on-exchange are much more likely to experience a financial barrier (OR: 2.4, P: 0.00).
Importance to public health: These findings imply that children's dental health may be at risk if children are shifted from private off-exchange or Medicaid and CHIP programs into marketplace coverage.