Abstract
OBJECTIVES: The aim of this study was to assess the relative strength of association of four state-level factors-Medicaid reimbursement, Medicaid adult dental benefit (MADB) generosity, dentist Medicaid participation, and dentist supply-on individual-level dental care use among children and adolescents in Medicaid. METHODS: This national cross-sectional study used 2018-2019 National Survey of Children's Health data to estimate dental care utilization among children aged 1-17 enrolled in Medicaid. Subgroup analyses were conducted by child age group. A hierarchical regression approach was used; a series of logistic regression models assessed relative effect sizes among the four state-level variables. RESULTS: Among children aged 1-17, and the age 1-3 subgroup, dentist Medicaid participation was positively associated with dental care use. Among children aged 4-11, children in states with Emergency/No dental coverage for adults had greater odds of having a dental visit compared to children in states with Extensive dental coverage. Among adolescents aged 12-17, no state-level factors were associated with dental utilization. CONCLUSIONS: There was considerable variation by age group in the associations of state-level factors on dental care use among children and adolescents in Medicaid. Dentist participation in Medicaid was associated with dental care use among very young children. State-level policy levers have the potential to improve access to dental care for children enrolled in Medicaid, and are critical to achieve improvement toward oral health equity for children.