Access to dental care services for Medicaid children: variations by urban/rural categories in Illinois.

Poor oral health status and limited access to dental care have been recognized as problems for children from Medicaid and low-income families. However, little is known about dental access for Medicaid-enrolled children in rural areas. This study examines differences between rural and urban counties in dental utilization rates of Illinois children enrolled in either Medicaid or the Children's Health Insurance Program. How the overall dentist supply, the dentist Medicaid participation rate, and county level sociodemographic factors relate to Medicaid dental utilization are examined. Illinois counties were aggregated into four urban/rural categories. Descriptive analysis showed lower utilization rates in the rural categories (25 and 27%) compared with the metropolitan categories (35 and 31%). Rural areas had a substantially lower supply of dentists, and consequently a lower supply of dentists participating in Medicaid, despite the substantially higher Medicaid participation rate of dentists in the rural categories (45 and 51%) than in the metropolitan categories (22 and 32%). However, regression results indicated no significant relationship between the rate of utilization of Medicaid-enrolled children and rural status after controlling for several dental supply and population factors. The most important factors relating to Medicaid-enrolled children's dental utilization, regardless of urban or rural status, were the proportion of children enrolled in Medicaid and the participating dentist to population ratio. Without the high participation rate of dentists in rural areas, access to oral health care for rural children enrolled in Medicaid would have been worse. Policy makers should focus on maintaining high rural dentist participation rates as well as addressing future supply problems that may exacerbate difficulties with access in rural areas.