Smile Alabama! Initiative: interim results from a program to increase children's access to dental care

Alabama faced an oral health crisis, with decreasing dental provider participation and increasing enrollment of Medicaid-eligible children. In response, the Smile Alabama! initiative was designed to improve oral health care services for Medicaid-eligible children by increasing the number of participating dentists by 15% and the number of children receiving dental care annually by 5% by January 31, 2004. The initiative is composed of 4 specific components: claims processing, dental reimbursement, provider education and recruitment, and recipient education. Specific interventions were implemented for each component. From fiscal year 1999 to fiscal year 2002, enrollment of targeted Medicaid children increased 32.7%. During this same period, the number of participating dental providers in the Alabama Medicaid dental program increased by 127 providers, a 38.7% increase. The number of children receiving dental services increased from 82,600 in fiscal year 1999 to 130,208 in fiscal year 2002, a 57.1% total increase, with a 4.8% increase in the annual dental visit rate. The experience suggests that access to oral health care services can be improved through a multidimensional, strategically planned dental outreach initiative in spite of dramatic increases in Medicaid enrollment.