The effectiveness and estimated costs of the Access to Baby and Child Dentistry program in Washington state MICHELLE KOBAYASHI, D.D.S., M.S.D.; DONALD CHI; SUSAN E. COLDWELL, Ph.D.; PETER DOMOTO, D.D.S., M.P.H.; PETER MILGROM, D.D.S. A ccess to dental health care for low-income children is a well-documented problem in the United States. 1 Although the federal Medicaid program mandates that every state provide preventive dental services for all Medicaid-eligible children, few children receive pre- ventive care by age 20 years. 2 For the most part, state legislatures have been unsuccessful in their efforts to increase access by expanding eligibility for Medicaid coverage. 2 In addition, a number of states have appro- priated funds to boost reimbursement fees to dentists only to learn that these measures alone do not increase the number of dentists willing to treat eli- gible children. 3 The Access to Baby and Child Den- tistry (ABCD) program was launched in Spokane County, Wash., in 1995 in an effort to increase the number of Medicaid-eligible children younger than 6 years who saw a dentist. At the heart of this program is a community-based strategy, which involves a combination of outreach and linkage, education for parents and dental professionals and delivery of services. 4-6 A recent study of the North Carolina Medicaid program con- cluded that “preschool-aged, Medicaid-enrolled children who had any early preventive dental visit were more JADA, Vol. 136 www.ada.org/goto/jada September 2005 1257 Programs such as Access to Baby and Child Dentistry have the potential to increase access to care and improve health. C O V E R S T O R Y likely to use subsequent preventive services and experience lower dentally related costs.” 7 The origin of the ABCD program is instructive. Two of us (P.D., P.M.) sought out concerned Medicaid staff members who had previously collabo- rated with University of Washington School of Medicine, Seattle, professors in improving prenatal care. The Medicaid officials actively sought ways to adapt Medicaid guidelines and pro- cedures to reduce the barriers to dentist Objectives. The authors estimated the effectiveness of the Access to Baby and Child Dentistry (ABCD) program as a tool to improve the oral health of children, and they measured its costs. ABCD is an effort to increase the utilization of dental care by Medicaid-enrolled children younger than 6 years. Methods. The authors compared the oral health of third-grade children in Spokane County Wash. (ABCD) with that of children in Pierce County (non-ABCD). They then compared the expenditures of ABCD with those associated with alternative dental care interventions. Results. Children in Spokane County had better oral health than did the children in Pierce County. The authors also found that the ABCD program increased mean dental care costs by $8.17 per user over costs in Pierce County, and the program cost a mean of $5.33 per user in outreach and dentist and staff training costs. Conclusions. This study found that ABCD improved the oral health of all third graders, including those not eligible or enrolled in the program. Increased expenditures were attributable mainly to outreach and training costs. Clinical Implications. Programs such as ABCD, carried out collaboratively by component societies, health districts, dental schools and Medicaid, have the potential to increase access to care and improve health. Key Words. Dental care for children; Medicaid; health services accessibility; program evaluation. ABSTRACT Copyright ©2005 American Dental Association. All rights reserved.