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Holes in the System: A critical analysis of the interconnected impacts of a Medicaid program on family dental access and care in California's San Joaquin Valley

  • Author(s): Kenny, Jazmine Day
  • Advisor(s): Burke, Nancy
  • et al.

Background: Medicaid-enrolled children have dental coverage, yet have higher rates of caries and untreated decay, and do not visit the dentist as often as privately insured children. I explored parent perspectives navigating the public dental system (Medi-Cal) in California’s San Joaquin Valley for themselves and their young children.

Methods: I conducted 25 in-depth, semi-structured interviews with parents whose children were enrolled in Medi-Cal across three San Joaquin Valley counties. Parents were asked to reflect on their family’s dental experiences and provide recommendations on improving navigation of the public dental system. I used a Constructivist Grounded Theory approach to inductively explore themes across transcripts, and co-constructed theories about parent narratives on reported social processes using my informed analyses on Medi-Cal policies.

Results: Parents reported long wait times between and during dental appointments and identified Medi-Cal system barriers related to low reimbursement rates and strained relationships with the dental field, which discourages dentists from participation in Medi-Cal and constrains the number of Medi-Cal participants who could have their dental needs addressed in a timely manner. Parents also experienced separate and unequal treatment compared to privately insured counterparts. I introduce a new concept of dental habitus (applied from Bourdieu’s concept of habitus) that is productive for thinking through how dental health-related experiences over the life course influence how individuals navigate the dental field.

Conclusion: Limited Medicaid-participating dental providers in areas with high enrollment hindered many families’ ability to seek timely, affordable care, and in some cases utilize dental benefits altogether. Despite coverage, families who face challenges accessing the dentist may not benefit from important dental care and information, which may constrain future use and contribute to dental disparities. Based on this study, I recommend state Medicaid policy improve the supply of dental providers and specialists (i.e., pediatric dentists) through increased reimbursement, improve relations with dental professionals, and encourage non-participating dentists to accept Medicaid since non-participation/limited participation has deleterious effects on population dental health.

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