Medicaid reforms in Oregon and suboptimal utilization of dental care by women of childbearing age.

BACKGROUND

The authors conducted a study of dental services used by women of childbearing age who were enrolled in Medicaid in Oregon during the early 2000s, a period of reform during which health care coverage was expanded. They compared claims for pregnant women, women who were not pregnant and had children and women who were not pregnant and did not have children. They also compared differences in claims between those for women enrolled in managed care and those for women enrolled in fee-for-service plans.

METHODS

The authors computed the proportion of women for whom a dental claim was submitted in six-month spans for 2000, 2001, 2002 (before reform) and 2005 (after reform).

RESULTS

Before and after reforms, the mean utilization rate for pregnant women, adjusted for the proportion of the period covered, decreased from 0.36 (standard deviation [SD] = 0.025) to 0.22 (SD = 0.028). Among women who were not pregnant and had children, the average adjusted rates decreased from 0.49 (SD = 0.201) to 0.21 (SD = 0.078). The pattern was similar among women who had no dependent children: rates decreased from 0.50 (SD = 0.028) to 0.19 (SD = 0.078). Most of the claims were for diagnostic services. The authors found no differences between women enrolled in managed care and those enrolled in fee-for-service plans.

CONCLUSION

Contrary to their intention, health care reforms in Oregon were detrimental to the vulnerable populations that Medicaid is intended to serve.

CLINICAL IMPLICATIONS

Dental care is important for maternal and child health. However, utilization is unlikely to improve without changes in Medicaid and the dental care delivery system.