Oral Health:

Factors Contributing to Low Use of Dental Services by Low-Income Populations

HEHS-00-149: Published: Sep 11, 2000. Publicly Released: Sep 25, 2000.

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William J. Scanlon
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Pursuant to a congressional request, GAO reviewed Medicaid and the State Children's Health Insurance Program's (SCHIP) efforts to make dental care more available to low-income people, focusing on: (1) factors that explain low dental service use by Medicaid and SCHIP beneficiaries; and (2) the role of other federal safety-net programs in improving access to dental care.

GAO noted that: (1) while several factors contribute to the low use of dental services among low-income persons who have coverage for dental services, the major one is finding dentists to treat them; (2) some low-income people live in areas where dental providers are generally in short supply, but many others live in areas where dental care for the rest of the population is readily available; (3) dentists generally cite low payment rates, administrative requirements, and patient issues such as frequently missed appointments as the reasons why they do not treat more Medicaid patients; (4) although many states have taken action to address these concerns, use remains low; (5) raising Medicaid payment rates for dental services--a step 40 states have taken recently--appears to result in a marginal increase in use but not consistently; (6) as expected, states that paid higher rates relative to the average fees dentists charge were more likely to report increases in dental utilization; (7) while 20 states use managed care to provide some dental services for Medicaid patients, state officials reported mixed results in terms of the extent to which this approach improves access; (8) although states have not yet evaluated the access to dental services under SCHIP, the majority of states have modelled their SCHIP dental services on their Medicaid programs and management and therefore expect to find similar utilization issues; (9) the impression of some officials in states that have departed from Medicaid in designing their SCHIP dental programs, such as using private insurance plans that pay higher rates, is that there are fewer access problems; (10) the four other major federal programs that target services or providers to underserved or special populations with poor dental health--the Health Center program, National Health Service Corps (NHSC), Indian Health Service (IHS) dental program, and IHS loan repayment program--currently have a limited effect on increasing the access to dental services that low-income and vulnerable populations have; (11) the Health Center program supports community and migrant health centers in medically underserved areas, while the IHS loan repayment program provides incentives for health professionals, including dentists, to practice in sites serving American Indians and Alaska Natives; (12) however, these programs are not able to meet the dental needs of their target populations; and (13) NHSC was able to fill only one of every three vacant dentist positions in underserved areas in fiscal year 1999.

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