title: Washington state foster care: dental utilization and expenditures.
abstract: OBJECTIVE
  To identify factors associated with dental utilization and expenditures for children enrolled in Washington State (WA) foster care (FC).
  
  
  METHODS
  This cross-sectional study used 2008 Medicaid enrollment and claims files for children ages <18 years enrolled in the WA FC program for ≥11 months (N = 10,177). Regression models were used to examine associations between utilization and expenditures and sex, race, age group, Supplemental Security Income (SSI) (i.e., disability), substance abuse, behavior problems, placement setting (Foster Home Care, Kinship Care, Group Care, Other), and urbanicity.
  
  
  RESULTS
  Only 43 percent of the children utilized any dental care; the adjusted mean expenditure was $198.35 [95% confidence interval (CI) $181.35, $215.36]. Fewer utilized diagnostic (41 percent), preventive (39 percent), restorative (11 percent), or complex (5 percent) services. Associated with utilization (P ≤ 0.01) were: female [ARR = 1.05, 95% CI(1.01, 1.10)]; 0-2 years [ARR = 0.18, 95% CI(0.15, 0.21)], [3-5 years ARR = 0.78, 95% CI(0.74, 0.83)]; Native American [ARR = 0.85, 95% CI(0.80, 0.91)]; SSI [ARR = 1.10, 95% CI(1.04, 1.17)]; Kinship Care [ARR = 0.94, 95% CI(0.90, 0.98)]; Group Care [ARR = 1.25 95% CI(1.15, 1.37)]; and urban/rural urbanicity with population <20 K [ARR = 1.20 95% CI(1.12, 1.30)]. Associated with expenditures (P < 0.05) were: ages 0-2 years [-$153.66, 95% CI(-$168.33, -$139.00)], 3-5 years [-$98.71, 95% CI(-$116.78, -$80.65)], 6-11 years [-$16.83 95% CI(-$33.52, -$0.14)]; African American [-$32.05 95% CI(-$47.99, -$16.12)]; Kinship Care [$28.57 95% CI($14.00, $43.15)].
  
  
  CONCLUSIONS
  Most children enrolled in WA FC for ≥11 months during 2008 did not receive dental care. Research is needed to determine the level of unmet need among children in FC and interventions to improve access to oral health of the children. Enforcement of existing federal legislation is needed.
authors.affiliation: Oral Health Sciences, University of Washington, Seattle, WA, USA.
authors.forename: Molly L R
authors.initials: ML
authors.lastname: Melbye
authors.forename: Donald L
authors.initials: DL
authors.lastname: Chi
authors.forename: Peter
authors.initials: P
authors.lastname: Milgrom
authors.forename: Colleen E
authors.initials: CE
authors.lastname: Huebner
authors.forename: David
authors.initials: D
authors.lastname: Grembowski
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D003752:Dental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D005581:Foster Home Care; D017048:Health Care Costs; D006801:Humans; D009909:Oral Health; D012044:Regression Analysis; D014861:Washington
keywords: access to health care; delivery of dental care; dental care for children; foster home care; oral health; pediatric dentistry