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Moving from Medicaid to North Carolina Health Choice: changes in access to dental care for NC children.

OBJECTIVE
The objective of this study is to identify the extent to which access to dental care changes as children move from a public program with low provider reimbursement and a reputation of non-compliant beneficiaries to another public program with higher reimbursement levels and enrollees that may be viewed differently by providers.


STUDY DESIGN
The pre- and post-enrollment dental experience of NC Health Choice enrollees who were previously on Medicaid is compared to those who were uninsured prior to NC Health Choice enrollment.


DATA SOURCE
Parents of newly-eligible NC Health Choice children were sent a survey within two weeks of enrollment to determine their child's experience prior to program enrollment. Respondents were resurveyed approximately 11 months later regarding their child's experiences after receipt of NC Health Choice.


PRINCIPAL FINDINGS
Medicaid recipients were significantly more likely to have had a dental visit within the year before enrolling in NC Health Choice, to report a usual source of care, and have fewer unmet needs than were uninsured children. After enrollment there was improvement for both groups, and differences between the two groups disappeared.


CONCLUSIONS
Medicaid coverage appears to improve access to dental services for children who would otherwise be uninsured. Increased access to dental services for Medicaid children after enrolling in NC Health Choice may be due to higher provider reimbursement, but may also result from providers' perception that NC Health Choice beneficiaries are a different population and more likely to keep appointments.


RELEVANCE
In a time of fiscal crisis, changes to NC Health Choice should be carefully considered to avoid loss of dental care gains afforded by this public insurance program.