Medicaid, a joint federal and state program which provides health care  coverage for low-income individuals and families; pregnant women; and  aged, blind, and disabled people, provided health coverage for an  estimated 20.1 million children aged 2 through 18 in federal fiscal year  2005. Dental Disease and Inadequate Receipt of Dental Care Remain Significant Problems for Children in Medicaid

Children in Medicaid aged 2 through 18 often experience dental disease  and often do not receive needed dental care, and although receipt of  dental care has improved somewhat in recent years, the extent of dental  disease for most age groups has not. Information from NHANES surveys  from 1999 through 2004 showed that about one in three children ages 2  through 18 in Medicaid had untreated tooth decay, and one in nine had  untreated decay in three or more teeth. Compared to children with private  health insurance, children in Medicaid were substantially more likely to  have untreated tooth decay and to be in urgent need of dental care. MEPS  surveys conducted in 2004 and 2005 found that almost two in three  children in Medicaid aged 2 through 18 had not received dental care in the  previous year and that one in eight never sees a dentist. Children in Medicaid also fared  poorly when compared to national benchmarks, as the percentage of  children in Medicaid ages 2 through 18 who received any dental care—  37 percent—was far below the Healthy People 2010 target of having   66 percent of low-income children under age 19 receive a preventive  dental service. MEPS data on Medicaid children who had received dental  care—from 1996 through 1997 compared to 2004 through 2005—showed  some improvement for children ages 2 through 18 in Medicaid. Projecting these proportions to 2005  enrollment levels, we estimate that 6.5 million children in Medicaid had  untreated tooth decay, with 2.2 million children having untreated tooth  decay involving three or more teeth. Survey data  also showed that about one in eight children (13 percent) in Medicaid  reportedly never see a dentist. In  contrast, about 40 percent of children with private insurance had a sealant. Comparison of Past and Recent Survey Data Suggests That the Rate of Dental Disease in Children in Medicaid Is Not Decreasing, although the Receipt of Dental Care Has Improved Somewhat in More Recent Years

While comparisons of past and more recent survey data suggest that a  larger proportion of children in Medicaid had received dental care in  recent surveys, the extent that children in Medicaid experience dental  disease has not decreased. This increase appears to be driven by younger children, as  the 2 through 5 age group had substantially higher rates of dental disease  in the more recent time period, 1999 through 2004. Data for  adolescents, by contrast, suggest declining rates of tooth decay. This change was statistically significant. Concluding Observations

The information provided by nationally representative surveys regarding  the oral health of our nation’s low-income children in Medicaid raises  serious concerns. In commenting on the draft, CMS  acknowledged the challenge of providing dental services to children in  Medicaid, as well as all children nationwide, and cited a number of  activities undertaken by CMS in coordination with states, such as  completing 17 focused dental reviews and forming an Oral Health  Technical Advisory Group. Appendix I: NHANES Analysis

The National Health and Nutrition Examination Survey (NHANES),  conducted multiple times since the early 1960s by the Department of  Health and Human Services’ (HHS) National Center for Health Statistics of  the Centers for Disease Control and Prevention (CDC), is designed to  provide nationally representative estimates of the health and nutrition  status of the noninstitutionalized civilian population of the United States. We also used standard  errors to calculate if changes from the 1988 through 1994 time period to  the 1999 through 2004 time period were statistically significant at the 95  percent level.
Why GAO Did This Study

In recent years, concerns have been raised about the adequacy of dental care for low-income children. Attention to this subject became more acute due to the widely publicized case of Deamonte Driver, a 12-year-old boy who died as a result of an untreated infected tooth that led to a fatal brain infection. Deamonte had health coverage through Medicaid, a joint federal and state program that provides health care coverage, including dental care, for millions of low-income children. Deamonte had extensive dental disease and his family was unable to find a dentist to treat him. GAO was asked to examine the extent to which children in Medicaid experience dental disease, the extent to which they receive dental care, and how these conditions have changed over time. To examine these indicators of oral health, GAO analyzed data for children ages 2 through 18, by insurance status, from two nationally representative surveys conducted by the Department of Health and Human Services (HHS): the National Health and Nutrition Examination Survey (NHANES) and the Medical Expenditure Panel Survey (MEPS). GAO also interviewed officials from the Centers for Disease Control and Prevention, and dental associations and researchers. In commenting on a draft of the report, HHS acknowledged the challenge of providing dental services to children in Medicaid, and cited a number of studies and actions taken to address the issue.

What GAO Found

Dental disease remains a significant problem for children aged 2 through 18 in Medicaid. Nationally representative data from the 1999 through 2004 NHANES surveys--which collected information about oral health through direct examinations--indicate that about one in three children in Medicaid had untreated tooth decay, and one in nine had untreated decay in three or more teeth. Projected to 2005 enrollment levels, GAO estimates that 6.5 million children aged 2 through 18 in Medicaid had untreated tooth decay. Children in Medicaid remain at higher risk of dental disease compared to children with private health insurance; children in Medicaid were almost twice as likely to have untreated tooth decay. Receipt of dental care also remains a concern for children aged 2 through 18 in Medicaid. Nationally representative data from the 2004 through 2005 MEPS survey--which asks participants about the receipt of dental care for household members--indicate that only one in three children in Medicaid ages 2 through 18 had received dental care in the year prior to the survey. Similarly, about one in eight children reportedly never sees a dentist. More than half of children with private health insurance, by contrast, had received dental care in the prior year. Children in Medicaid also fared poorly when compared to national benchmarks, as the percentage of children in Medicaid who received any dental care--37 percent--was far below the Healthy People 2010 target of having 66 percent of low-income children under age 19 receive a preventive dental service. Survey data on Medicaid children's receipt of dental care showed some improvement; for example, use of sealants went up significantly between the 1988 through 1994 and 1999 through 2004 time periods. Rates of dental disease, however, did not decrease, although the data suggest the trends vary somewhat among different age groups. Younger children in Medicaid--those aged 2 through 5--had statistically significant higher rates of dental disease in the more recent time period as compared to earlier surveys. By contrast, data for Medicaid adolescents aged 16 through 18 show declining rates of tooth decay, although the change was not statistically significant.