Dental Care in the Los Angeles Healthy Kids Program: Successes and Challenges

Abstract

Overall, the Los Angeles Healthy Kids program has greatly improved coverage and access to dental care services for children enrolled in the program. However, as with many public insurance programs, the Los Angeles Healthy Kids program has been confronted with numerous challenges in meeting the dental care needs of program enrollees, such as initially assigning different dentists to some enrollees than they had selected, confusion over charges for dental services and underreporting of encounter data.

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Introduction

Tooth decay is the most prevalent chronic childhood illness, and primary dental care is the most significant unmet children's health need. In California, oral disease among children is a major public health challenge, and particularly severe in Los Angeles County. The Los Angeles Healthy Kids program was implemented in 2003 to address unmet health care needs among children, and provide comprehensive, affordable health care coverage to uninsured children from families with incomes under 300 percent of the federal poverty level (FPL), who are not eligible for the Healthy Families or Medi-Cal programs. To address unmet dental care needs among its target population, the Healthy Kids coverage package was designed with a comprehensive dental benefit.

This study examines dental care access in the Los Angeles Healthy Kids program, synthesizing findings from several components of the Healthy Kids Program Evaluation—launched in 2004 to monitor the program's implementation and impact—and presents new results from analysis of encounter data from SafeGuard Dental, the program's dental carrier. Findings suggest that Healthy Kids has improved children's access to dental care and addressed unmet dental care needs, but that there remains a need for improvement in some aspects of the program.

BACKGROUND

In 2000, the landmark U.S. Surgeon General's Oral Health in America report identified tooth decay as the most common chronic illness among children, affecting five times as many children as asthma, and contributing to nearly 51 million hours of missed school each year (U.S. Department of Health and Human Services 2000). Oral disease can affect children's growth, speech development, nutrition, learning, and overall quality of life. The American Academy of Pediatric Dentistry (2009) recommends that all children have a dental care visit within six months of getting their first tooth and no later than their 1^st birthday, and at least bi-annually thereafter through their 18^th birthday.

However, many children do not receive adequate dental care due to access barriers such as family income, language and cultural barriers, and lack of dental insurance coverage. Numerous studies have documented the existence of income and racial/ethnic disparities in dental care access and oral health status. Low-income children (in families with incomes less than 200 percent FPL) are twice as likely as higher-income children to have tooth decay and unmet need for dental care; and low-income children without health insurance are twice as unlikely as their insured counterparts to receive preventive dental care (Kenny, Ko, and Ormond 2000; Kenny, McFeeters, and Yee 2005; Dye et al. 2007). Children of color, particularly Latino, African-American and American Indian/Alaskan Native children, are more likely to have unmet dental care needs and experience severe oral disease (Mouradian, Wehr, and Crall 2007). Additionally, children who are not U.S. citizens have been found to be twice as likely as children who are citizens to receive no preventive dental care (Kenny et al. 2005).

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