# Evaluation of an Innovative School-Based Initiative to Improve Receipt of Preventive Dental Care among Children Enrolled in Medicaid

> **NIH AHRQ R01** · GEORGETOWN UNIVERSITY · 2021 · $400,000

## Abstract

Project Summary
 Untreated tooth decay is the most common childhood chronic disease and is particularly acute
among low-income children and adolescents, including those with Medicaid coverage. Lack of access to
a dental provider, the high costs of care and lack of dental insurance coverage are the primary reasons why so
many children do not obtain needed dental care. This proposed research will be the first to evaluate the
causal impact of an innovative school-based program specifically tailored to address unmet dental
needs among low-income children. This supply-side initiative enables dental hygienists employed by the
Virginia Department of Health (VDH) to deliver preventive dental services to low-income children at “high-need”
schools under the remote supervision of a public health dentist. A hygienist practicing under “remote
supervision” has periodic communication with a public health dentist regarding patient care although the public
health dentist has not performed an oral exam on the children screened and treated by the dental hygienist.
The program was initially piloted during the 2009-2010 academic year in “high-need” schools located in three
health districts with high levels of unmet dental care needs and was expanded statewide in July 2012.
 We propose to analyze Medicaid enrollment and claims records (MAX data) spanning the years 2006
through 2016 to evaluate the causal impact of this highly innovative school-based dental care delivery model.
We will use difference-in-differences analysis to compare receipt of preventive dental services among children
who attend schools where a dental hygienist practices under remote supervision to receipt of preventive dental
services among children who attend “high-need” schools without this program. We will first evaluate the pilot
program and then conduct a similar evaluation after the program was expanded and became available in
additional health districts located throughout the state of Virginia. The rationale for evaluating both the pilot and
expansion of this school-based initiative is twofold. First, the health districts selected to participate in the pilot
program had very high levels of unmet dental care need and thus may yield a distorted picture of the true
impact of the program. Second, an evaluation of a new program during its infancy may reflect implementation
difficulties that are resolved over time. Thus, a comparison of the results from the pilot program and expansion
of the program to additional health districts will address both of these concerns.
 Notably, the program itself represents a highly innovative solution to the dental care access crisis that
exists among low-income children. Other policy solutions, such as increasing Medicaid reimbursement rates or
the licensing of dental therapists—either have been found to be ineffective (Decker 2011; Buchmueller et al.
2015) or face intense opposition from practicing dentists (McElhaney 2014). Thus, our proposed evaluation will
prov...

## Key facts

- **NIH application ID:** 10199042
- **Project number:** 5R01HS025430-03
- **Recipient organization:** GEORGETOWN UNIVERSITY
- **Principal Investigator:** Jean M Mitchell
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $400,000
- **Award type:** 5
- **Project period:** 2019-07-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10199042

## Citation

> US National Institutes of Health, RePORTER application 10199042, Evaluation of an Innovative School-Based Initiative to Improve Receipt of Preventive Dental Care among Children Enrolled in Medicaid (5R01HS025430-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10199042. Licensed CC0.

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