By Sophia Duong

Tooth decay still remains the most common chronic disease for children in the U.S. today. Progress has been made to address this problem, including a provision in CHIPRA that expanded dental coverage for all children enrolled in CHIP. CHIP has been a vital source of dental health coverage for low-to-middle income children. And now we have evidence that CHIP coverage has been effective in addressing this prevalent need among children.

As a supplemental report from the CHIPRA evaluation, researchers from The Urban Institute and Mathematica Policy Research analyzed measures of children’s access to dental health care and outcomes by examining data from a 2012 survey of parents of CHIP enrollees in 10 states (Alabama, California, Florida, Louisiana, Michigan, New York, Ohio, Texas, Utah, and Virginia). The authors also surveyed parents whose children had been uninsured or privately insured to compare those experiences with the experiences of children currently enrolled in CHIP. The results reinforce the fact that CHIP is an important source of coverage for children and surpasses many private plans in meeting children’s dental health needs.

Oral Health Access for Children Enrolled in CHIP

From the results of parents whose children were enrolled in CHIP:

•  5 percent reported that their child had dental coverage
• 6 percent reported they had no trouble finding a usual source of dental care
• 84 percent of CHIP enrolled children had a preventive dental visit in the past year

However, when asked about their children’s teeth, only 52 percent of parents responded that their children’s teeth were in excellent or very good condition, and 12 percent reported that they had an unmet dental care need. With higher coverage and access rates for dental care, it appears there are other factors contributing to a child’s dental health that need to be studied further. So how do these compare to the uninsured and those enrolled in private coverage?

CHIP Coverage Compared to the Uninsured

Unsurprisingly, children enrolled in CHIP fare better with dental coverage and care than uninsured children. Compared to children who are uninsured, children enrolled in CHIP are:

• 1 percentage points more likely to have dental care
• 2 percentage points more likely to have a usual source of dental care
• 6 percentage points more likely to have had a dental cleaning or checkup in the past year
• 1 percentage points less likely to have an unmet dental care need

CHIP Coverage Compared to Private Coverage

Perhaps surprising to some, children covered by CHIP had increased access to dental care compared to children enrolled in private insurance. When compared to children enrolled in private plans, children enrolled in CHIP are:

•  7 percentage points more likely to have dental coverage
• 8 percentage points more likely to have a usual source of dental care
• 3 percentage points more likely to have had a dental cleaning or checkup in the past year
• There was no difference in reported unmet need for dental care between children enrolled in CHIP and children enrolled in private insurance, which was 12 percent

On the flip side, there are a few measures that privately-insured children are reportedly doing better than children enrolled in CHIP, specifically the measures on perception of the child’s oral health. Parents of children in private insurance were 7.1 percentage points more likely to report that their children’s oral health is in excellent or very good condition than parents of children enrolled in CHIP.

More Work to be Done

Dental care is one of the most pressing health care needs for children, and this research reinforces that CHIP is meeting the dental coverage and access needs of children better than private insurance. At CCF, we are not surprised by this data, as CHIP was designed specifically with children’s needs in mind.

Of course, there is still more work to be done, particularly in the areas of unmet dental care needs and oral health outcomes. As policymakers and other stakeholders consider the future of children’s coverage, programs must take into account children’s needs and build upon the strong foundation of coverage that has already been established. Re-structuring is certainly needed, but removing a pillar of coverage such as the CHIP program without any reinforcements could mean a landslide for children’s coverage and access to care.