Dental Utilization by Mentally Retarded or Developmentally Disabled Medicaid-Enrolled Children

Objective: This descriptive study estimated dental service utilization rates of mentally retarded or developmentally disabled (MRDD) special needs children enrolled in the Iowa Medicaid program.

Methods: We analyzed Medicaid dental claims submitted between 01/01/2005 and 12/31/2005 on behalf of MRDD children less than 18 years of age (n=4,813) who were eligible for Medicaid for at least 11 months in 2005. A child was considered to be MRDD if he or she met any of the following five criteria: 1) had an ICD-9 diagnosis of autism, mental retardation, cerebral palsy, spina bifida, or fragile X syndrome on any Medicaid medical claim filed between 2000 and 2005; 2) was institutionalized in an Institutional Care Facility for the Mentally Retarded or state facility for the mentally retarded; 3) received targeted case management services; 4) was enrolled in the Home and Community Based Services Waiver Program for the Mentally Retarded; or 5) had a Medicaid claim with a Mental Retardation or Developmental Disability exception indicator. An overall dental service utilization rate estimated the proportion of Medicaid-eligible children with at least one dental claim in 2005. Four additional measures based on Current Dental Terminology 9 and 10 codes were created to estimate the proportion of children with a diagnostic, preventive, routine restorative, or complex restorative dental claim. These service type-specific utilization rates were calculated as a proportion of all Medicaid-eligible children with at least one dental claim.

Results: Over 50% of children had at least one dental claim in 2005 (2,415). Among this subset of children, about 90% had a diagnostic or preventive claim whereas less than 30% had a routine restorative or complex restorative claim.

Conclusions: Targeted interventions might focus on increasing access to dental care services for the approximately 50% of MRDD children enrolled in the Iowa Medicaid program without a dental claim in 2005. Future studies should seek to further understand the relationship between dental utilization rates and unmet dental needs.

Supported by NIH Grant T32-DE014678