Education Expenditure and Preventive Dental Care Use for Medicaid-Enrolled Children

Abstract

Purpose: The aim of this retrospective, cross-sectional analysis of school districtexpenditure and Medicaid claims data was to evaluate the relationship between public education expenditure and preventive dental care use in Medicaid-enrolled children in Washington Methods: We obtained publicly available per-pupil public school district-levelexpenditure data in Washington state in U.S. dollars (2019-2020 academic year) from the Washington Office of Superintendent of Public Instruction. School-aged children ages 5 to 18 years who were enrolled in Washington State Medicaid in calendar year 2019 with a valid mailing address were identified and geocoded into a unique public school district. School district-level preventive dental care use for Medicaid enrollees ages 5 to 18 years was calculated from the Medicaid claims data. The primary outcome was school districtlevel preventive dental care use. The main predictor variable, school district-level perpupil public school expenditure, was classified into quartiles. Associations were evaluated using unadjusted and confounder-adjusted linear regression models with robust standard errors (α=0.05). We also ran stratified models to examine whether results differed for urban and rural school districts. Findings: There were 296 school districts in Washington state with a mean per-pupilexpenditure of $17,265 (standard deviation: $6,468; range: $10,784 to $52,335), and there were 735,457 children ages 5 to 18 years enrolled in Washington state Medicaid in 2019. Mean enrollee age was 11.2 years (standard deviation: 4.1 years), 49% were female, 50% were white, and 84% lived in a rural community. About 42.7% of Medicaid enrollees utilized preventive dental care in 2019. In the unadjusted analyses, Medicaidenrolled children in the highest school district expenditure quartile utilized preventive dental care (40%, SD 0.09) significantly less frequently than those in the lowest, second lowest and third lowest expenditure quartiles (44%, 45% and 45%, respectively; p<0.01). The confounder-adjusted models yielded the same results. Furthermore, in the stratified models the observed association remained statistically significant only for rural school districts. Conclusions: Public school spending is associated with preventive dental care use forschool-aged children in Medicaid but only in rural communities. Future research should continue to explore how district-level public school expenditure data could be used to target preventive dental care interventions for the most vulnerable school-aged children enrolled in Medicaid.