Comparison of Access and Costs of Medicaid Dental Services in a Hospital Clinic and Community Practices

Reports the results of a three-year evaluation of access to dental care and its associated costs for Aid to Families with Dependent Children (AFDC) beneficiaries enrolled in a hospital-based health maintenance organization (HMO) or a fee-for-service (FFS) option. Medicaid enrollees (n=3,655) with a year of eligibility were assigned to either the hospital HMO or FFS care, and their use of dental care and its costs were compared. The authors found that a higher percent of those beneficiaries enrolled in the FFS option used dental care than did hose in the HMO plan. FFS enrollees also had more annual visits per person than those in the randomly assigned HMO group. FFS dental patients treated in the hospital had the highest costs of any payment-provider combination studied. To understand the mix of utilization rates, visits, and costs, one must first understand how the HMO hospital plan, dental department, and dental provier are reimbursed.