Dental care utilization under the Los Angeles Healthy Kids Program: Successes and challenges

The Los Angeles Healthy Kids Program was launched in 2003 to extend comprehensive health insurance to children in families with incomes below 300 percent of poverty who are ineligible for Medi-Cal and Healthy Families. This study draws upon results from multiple qualitative and quantitative components of a five-year evaluation of the program, begun in 2004, and presents new results from analysis of encounter data from the program's dental plan. Findings indicate that coverage and delivery of general and specialty dental services through Healthy Kids has not gone entirely smoothly. Case studies found that children were often assigned to different dentists than their parents had selected, leading to confusion and delays in obtaining care. In focus groups, most parents reported their children received high quality dental care, yet also spoke of long waits for appointments. Many parents complained that they were inappropriately charged for dental services, sometimes as much as $100 for fillings. Household survey results reveal that Healthy Kids enrollment is associated with improved access to a usual source of dental care, yet recent analysis of dental plan encounter data indicates that only 40 percent of enrollees received care in 2007, the lowest rate among all California Healthy Kids programs. Thus, while the Healthy Kids Evaluation has demonstrated that the program greatly improved coverage and access to health services for nearly 40,000 poor, undocumented, Latino children, it also finds that, like many public insurance programs, Healthy Kids has been confronted numerous challenges in meeting the dental care needs of children.