Impact of increasing Medicaid dental reimbursement and implementing school sealant programs on sealant prevalence

We examined the impact of two financing strategies--increasing Medicaid dental reimbursements and providing school sealant programs--on dental sealant? prevalence (number of children with at least one sealant) among 7- to 9-year-olds in Alabama and Mississippi counties from 1999 to 2003.

We used Medicaid claims data in a linear regression model. We regressed number of children sealed per county onto eligible children, median family income, dentist-to-population ratio, and indicator variables for reimbursement increase, presence of community health center (CHC) or school sealant program, and interaction between reimbursement increase and presence of school program or CHC. We also calculated the average incremental cost per sealant from increasing the Medicaid reimbursement rate and then disaggregated it into cost to provide additional sealants and cost to provide the same number of sealants under the higher rate.

Increasing the sealant reimbursement rate was associated with a 102 percent increase and a 39 percent increase in sealant prevalence in Mississippi and Alabama, respectively. Introducing school sealant programs more than doubled sealant prevalence in both states. In Mississippi, 85 percent of the average incremental cost from implementing the higher reimbursement rate was due to providing new sealants and 15 percent was due to paying a higher rate for sealants that likely would have been delivered at the old rate.

Depending on supply and demand conditions in dental markets, both strategies can be effective in increasing sealant prevalence.