The impact of dental Medicaid reform on dental care provider activity and market penetration of dental support organizations

• Published in: The Journal of the American Dental Association (1939) Vol. 152; no. 10; pp. 822 - 831
• Main Authors: Brickhouse, Tegwyn H., Dahman, Bassam A., Peters, Barrett W.R., Liu, Hangcheng, Kumar, Anita M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.10.2021
• Subjects: Access, demand, use of services; Child; child and adolescent health; Dental Care; dentistry; governance; Humans; Medicaid; ownership; Private Practice; Retrospective Studies; United States; United States; SES; DSO; child and adolescent health; dentistry; dental care; VDMAS; Access, demand, use of services; FY; ownership; DQA; VDH; Medicaid; governance
• ISSN: 0002-8177; 1943-4723
• DOI: 10.1016/j.adaj.2021.05.007

Medicaid state dental programs have experienced changes related to provider practice settings with the increased growth of dental support organizations (DSOs). The authors conducted this study to assess the impact of state Medicaid reform on the dental practice environment by examining provider activity and practice setting. This was a retrospective cohort study of more than 13 million dental claims in the Virginia Medicaid program. It included children and dental care providers in the Virginia dental Medicaid program at some time during a 9-year period (fiscal years 2003-2011). The independent variable was the provider practice setting: private practice, DSO, and safety-net practice. The outcomes included annual measures of claims, patients, and payments per provider. The outcomes were examined over 3 phases of the study period: prereform (2003-2005), implementation phase (2006-2008), and postreform maturation (2009-2011). Provider activity increased after dental program reform, with private-practice providers delivering most of the dental care in the Medicaid program. There was a significant penetration of DSO providers in number of providers, claims per provider, and patients per provider (P < .001). Regression results found that providers in DSO settings had an increased number of patients and claims compared with private-practice providers. Medicaid reform has resulted in a significant increase in provider participation and growth of DSO-affiliated providers. Areas of the state with more dense population had a higher penetrance of dentists practicing in DSO settings providing dental services to children enrolled in Medicaid.