Ethnic disparities in Medicaid dental utilization in San Francisco

Objective: To inform tailored oral health interventions, this panel study aimed to analyze dental utilization rates among children in San Francisco enrolled in California's fee for service Medicaid dental program (“Denti-Cal”), by ethnicity and age, and to identify ethnic and/or age groups with disproportionately low utilization. Methods: Data, reported by the California Department of Health Care Services for children with residence in San Francisco and eligible for Denti-Cal services during FY2003-2012, were used to determine the number and proportion of eligible children and youth utilizing Denti-Cal by race/ethnicity (136,703 out of 322,313 eligible, ages 0-20). Mixed models were used to test for significant between-group differences in the utilization rates and trends by age. Results: Between 2003 and 2012, there was an overall increase of 18.8% in the Denti-Cal utilization rate among children ages 0-20. However, there were greater increases among children ages 0-8 than ages 9-20 (53.1% vs. 2.7%) respectively. Chinese (35.1%) and Hispanic (41.6%) children were the only ethnic groups with significant increases over this period. Furthermore, there was an overall significant increase among children ages 0-20 (22.3%) from 2008-2012 vs. (0.7%) from 2003-2007. There was a particularly significant increase (107.7%) in the use of Denti-Cal services among children 0-3 years in the last 5 years. Conclusions: Based on preliminary analysis, there were significant increases in Denti-Cal utilization rate among children 0-3 years, and among Chinese and Hispanic ethnic groups. However, disparities still exist among other ethnic and/or age groups, even with access to free dental services through Medicaid.