Evaluating network adequacy of oral health services for children on Medicaid in Arizona

PURPOSE: Inadequate networks can prevent patients from being able to see the providers that they trust and depend upon, especially for children insured through Medicaid. To improve our understanding of poor oral health care outcomes, we conducted a test of network adequacy among Medicaid pediatric dental providers in Arizona through a “secret shopper” phone survey. METHODS: This study tested multiple components of children's access to oral health care, including reliability of provider directory information, appointment availability at the practice level for children covered under Medicaid versus commercial insurance, and compliance with regulatory standards. We contacted individual providers, following a standardized script to schedule a routine appointment on behalf of a 5-year-old patient enrolled in either a Medicaid or commercial plan. We documented the time until the next available appointment, if the practice was reached, and if the practice accepted the specified insurance plan. RESULTS: We identified, catalogued, and attempted to call a total of 185 unique practices across Arizona. In four counties, we were unable to identify a single pediatric oral health provider through health plan directories. We observed minimal differences in appointment wait times between callers with commercial insurance and those insured through Medicaid. CONCLUSIONS: Our findings underscore the need to improve the accessibility of pediatric health services, especially in rural regions. Facilitating access to routine and recommended oral health screenings for children enrolled in Medicaid is imperative to appropriate stewardship and fulfilling our commitment to provide this vital public health resource.