Dissertation/Thesis Abstract

Oral health access for Medicaid -enrolled children: An unfulfilled promise
by Daneman, Barry Steven, Ph.D., University of Missouri - Kansas City, 2009, 169; 3394767
Abstract (Summary)

Children enrolled in the federal-state Medicaid Program have a legal entitlement to receive basic preventive and restorative dental services, yet fewer than one in three receive care in any given year. This study seeks to explain why.

Drawing on a health services utilization framework, the study describes a number of weaknesses in the design and implementation of Medicaid Dental Programs. On the consumer side, children and their adult care-givers face a variety of barriers that make it difficult for them to access care. These range from not understanding their benefits, to not knowing how to make appointments, to problems of getting time off from work to finding reliable transportation. On the provider side, inadequate reimbursements, complicated administrative procedures and difficulties in working with Medicaid patients discourage participation.

These problems are remediable, however. The study presents a detailed overview and analysis of twelve highly-successful state and community strategies for addressing the deficiencies of the Medicaid Dental Program. Such efforts include a wide variety of education and outreach programs, mobile and school-based programs, workforce and pipeline programs, and financing and administrative reforms.

Still, in any given year, nationally, fewer than one child in three receives the preventive and restorative dental care Medicaid promises them. Progress is difficult to achieve.

What is needed to make progress? Drawing on three models of the policy process, the dissertation presents a comparative case study of the Kansas and Missouri Dental Medicaid Programs from 1999 to 2009. Kansas made significant progress throughout the ten-year period, while Missouri struggled.

The study suggests that four conditions are important for achieving progress in oral health policy: a united oral health policy community, a skilled policy entrepreneur willing to invest his/her resources to make a difference, an active and effective oral health coalition and, inside of government, a state dental director.

Indexing (document details)
Advisor: Herman, Robert D.
School: University of Missouri - Kansas City
School Location: United States -- Missouri
Source: DAI-A 71/02, Dissertation Abstracts International
Subjects: Dentistry, Public administration, Public policy
Keywords: Advocacy coalitions, Medicaid-enrolled, Oral health, Policy process, Public entrepreneurs
Publication Number: 3394767
ISBN: 9781109619713
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