Access, Use, and Costs of Dental Services in the Healthy Kids Program

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Abstract

This brief presents data on dental coverage benefits and enrollee's access and use of dental services through the Healthy Kids program in San Mateo County, California, which offers subsidized health and dental insurance for children living below 400 percent of federal poverty who are ineligible for Medi-Cal and Healthy Families (California's SCHIP program). Healthy Kids dental coverage has led to use of dental services among a sizable portion of enrollees. Children seeking dental services were more costly for the program than other enrollees, and dental care costs accounted for a large proportion of the overall cost of their healthcare. While there is adequate service capacity to meet children’s dental needs in the county, renewed efforts to link enrollees with dental care are needed.

Introduction

Tooth decay is a significant problem. By 3rd grade, it affects two-thirds of children in California. Some 750,000 elementary school children—28 percent—have untreated tooth decay (Dental Health Foundation 2006). Poor children and children of color—particularly Latino children—are much more likely to have tooth decay and suffer the consequences of untreated disease (Dental Health Foundation 2006). For every child without medical insurance, 2.6 children lack dental insurance. Children from families without medical insurance are 2.5 times less likely than insured children to receive dental care. Children from families without dental insurance are 3 times more likely than insured children to have unmet dental needs¹.

This brief provides data from San Mateo County, California, a county that provides subsidized health and dental insurance to uninsured children living in families with incomes below 400 percent of the federal poverty level who are ineligible for Medi-Cal (the federal-state insurance program for low-income children) and Healthy Families (California's SCHIP program) due to family income or documentation status. This coverage is provided through the Healthy Kids program, which falls under the Children’s Health Initiative (CHI), an effort to extend health insurance to virtually all children in the county either through Healthy Kids, Medi-Cal, or Healthy Families.

San Mateo County has undertaken a five-year evaluation of Healthy Kids, providing a rare window into various aspects of access to and use of services among previously uninsured children, including access to and use of dental care. Further, the evaluation provides examples of how a locally based program has instituted policies and practices designed to increase use of dental services among Healthy Kids members. These local examples may serve as "smart practices" for other county, state, or even national programs. More information on the San Mateo CHI and the Healthy Kids program is available in three annual reports².

¹ See Centers for Disease Control and Prevention, “Children’s Oral Health” fact sheet, http://www.cdc.gov/oralhealth/factsheets/sgr2000-fs3.htm.
² See Howell et al. (2004, 2005, 2006).

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Disclaimer: The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.