COMPARISON OF ACCESS AND COSTS OF MEDICAID DENTAL SERVICES IN A HOSPITAL CLINIC AND COMMUNITY PRACTICES

Objectives: This paper reports the results of a three-year evaluation of access to dental care and its associated costs for Aid to Families with Dependent Children (AFDC) beneficiaries enrolled in a hospital-ba sed health maintenance organization (HMO) or a fee-for-service (FFS) o ption. Methods: Medicaid enrollees (n=3,655) having a year of eligibil ity were assigned to either the hospital HMO or FFS care, and their us e of dental care and its costs compared. Results: A higher percent of those beneficiaries enrolled in the FFS option used dental care than t hose in the HMO plan. FFS enrollees also had more annual visits per pe rson than those in the randomly assigned HMO group. FFS dental patient s treated in the hospital had the highest costs of any payment-provide r combination studied. Conclusions: To understand the mix of utilizati on rates, visits, and costs, one must take into account the way in whi ch the HMO hospital plan is reimbursed, the way in which the dental de partment is reimbursed, and the way in which the dental provider is re imbursed.