36 - Medicaid Managed Care and Dental OR Access in North Carolina

Purpose: This study examined the impact of North Carolina’s transition of medical Medicaid to Managed Care (while retaining fee-for-service dental Medicaid) on children’s access to dental services in an operating room environment.  

Methods: This investigation utilized the NC Hospital Outpatient and Ambulatory Surgery Discharge Data to observe general anesthesia visits for fiscal years (FY) 2017-2022. A pre-test/post-test design with concurrent comparison groups were used to compare: (1) children treated for dental caries compared to those treated for otitis media and (2) children whose treatment for dental caries was reimbursed by Medicaid compared to those whose treatment for dental caries was not reimbursed by Medicaid.  

Results: In the pre-managed care period (FY2017; FY2018), there were 24,211 visits for dental caries and 38,016 visits for otitis media. Following transformation to medical Managed Care (FY2021; FY2022), dental visits increased to 28,301 (17%) and otitis media visits decreased to 19,872 (-48%), (P < .05). Increase in dental visits was significantly higher (P < .05) for children whose visits were paid by non-Medicaid sources (70%) versus visits paid by Medicaid (9%). The contrast between payer sources for otitis media visits was less severe, with the visits paid by non-Medicaid sources decreasing by 54% versus a 32% decrease in visits paid by Medicaid. These differences were consistent when adjusting for population and enrollment changes.  

Conclusions: Following NC’s transformation to medical Medicaid Managed Care while retaining fee-for-service dental Medicaid, there was a greater increase in dental OR visits for those covered by non-Medicaid payers than those covered by Medicaid. 

Identify Supporting Agency and Grant Number: Research supported by UNC Pediatric Dentistry research funds.