Preventive oral health care use for children with special health care needs aged 6 through 12 years enrolled in Medicaid: A mixed methods study

Abstract

Background: The authors aimed to assess preventive oral health care (POHC) use for children with special health care needs (CSHCN) aged 6 through 12 years enrolled in Medicaid and identify intervention strategies to improve oral health.

Methods: In this sequential mixed methods study, the authors analyzed 2012 Medicaid data for children aged 6 through 12 years in Washington state. They used eligibility and claims data to identify special health care needs status (independent variable) and POHC use (outcome variable). They ran modified Poisson regression models to generate prevalence rate ratios. They coded data from 21 key informant interviews deductively using content analytic techniques.

Results: Of the 208,648 children in the study, 18% were identified as CSHCN and 140,468 used POHC (67.3%). After adjusting for confounding variables, the authors found no difference in POHC use by special health care need status (prevalence rate ratio, 1.00; 95% CI, 0.99 to 1.01; P = .91). In the qualitative analysis, the authors identified 5 themes: caries risk depends on a child's specific health condition, caries complicates overall health, having a special need creates a bigger barrier to care, legislation alone is "not going to make much of a dent," and improvements across all fronts are needed to promote the oral health of CSHCN in Medicaid.

Conclusions: CSHCN enrolled in Medicaid are just as likely as children without special health care needs to use POHC, although barriers to oral health care access persist for CSHCN.

Practical implications: Future efforts should focus on comprehensive strategies that address the varying levels of dental disease risk and difficulties accessing oral health care within the diverse group of CSHCN.

Keywords: Medicaid; children with special health care needs; dental care; mixed methods; oral health; reimbursement rates.