Institute Says Research Shows “ghost” Dental Network Directories Hurt Kids

By Carol Ann Campbell
For the New Jersey Health Care Quality Institute

For parents seeking dental care for their children, the search for a dentist who accepts Medicaid insurance can be a frustrating and sometimes futile endeavor.

The New Jersey Health Care Quality Institute explains why in a report, released in February, that found nearly half the dental providers listed in Medicaid managed care directories would not schedule an appointment for a young child.

The Quality Institute conducted “secret shopper” research and called all 824 general and pediatric dental practices listed in the five Medicaid Managed Care Organization (MCO) directories for children ages 0 to 6 to schedule an appointment for a two-year-old child.

The findings show that 51 percent of the time, the MCO providers would not schedule an appointment.

These inaccurate directories, sometimes called “ghost networks,” indicate that MCOs are not meeting their contractual obligation to the State and that NJ Medicaid is failing to effectively enforce its contracts with the MCOs. 

The data reveal alarming gaps in access for basic preventive dental care: 

• Only 49% of the listed dental practices (in the directories for children ages 0 to 6) would schedule an appointment for a two-year-old child, despite the practices being listed in those directories. 
• 37% of dental practices in the 0 to 6 directories said they did not, in fact, accept the specific insurance even though they were listed as being in network. 
• 14% of the practices were unreachable, with no answer after two attempts. 

Early dental visits are essential to prevent cavities, establish good oral hygiene habits, identify potential issues before they worsen, and are foundational to overall health and well-being.

Despite long-standing recommendations from the American Academy of Pediatrics, the American Dental Association, and others, that children receive dental care by their first birthday, many New Jersey families struggle to find essential dental care for their children.  

The five Medicaid MCOs are: Aetna Better Health of New Jersey; Wellpoint; UnitedHealthcare Community Plan; Horizon NJ Health; and Fidelis Care.

All five of the MCOs receive federal and state funds monthly to ensure that their NJ FamilyCare members receive regular dental care. 

The findings align with the State’s basic screening survey of children in third grade, which found that 36% of third graders have untreated tooth decay, nearly double the national average of 20%, according to the NJ Department of Health 2022-2023 Oral Health Status of New Jersey’s Third Grade Children Basic Screening Survey.

Children attending the lowest-income schools have a significantly higher prevalence of tooth decay, compared to children in higher-income schools.

They also are much more likely to require urgent dental care due to pain or infection. Untreated tooth decay can lead to missed school, pain, tooth loss and infection as well as impact life experiences and self-confidence. 

The Quality Institute calls on state leaders and regulators, children’s advocates, MCOs, dentists and other health professionals to join together and take action by:

Expanding Dental Provider Networks: Increase the number of dental practices equipped and willing to participate in NJ FamilyCare. Expanding networks requires increasing the rates that are paid to dentists in Medicaid. The rates that the NJ MCOs currently pay dentists are in the bottom 10 percent in the country.

Improving Directory Accuracy: Medicaid MCOs must audit and update their provider directories regularly to ensure they reflect accurate and reliable information. Specifically, the Medicaid program should audit and better enforce its current MCO contract and thereby live up to its obligation to provide dental benefits to children enrolled in NJ FamilyCare.

Raising Awareness: State leaders, MCOs, and dental providers must educate the general public as well as other health care providers, teachers, families, and caregivers about the importance of establishing a dental home and prioritizing dental visits by the child’s first birthday. 

“Every child deserves a strong foundation of oral health, yet these findings reveal systemic barriers that prevent many New Jersey families enrolled in NJ FamilyCare from accessing this essential care,” said Linda Schwimmer, President and CEO of the Quality Institute. 

The Quality Institute’s secret shopper research was inspired by the experiences of Dr. Nicole McGrath-Barnes and her colleague Dr. Michal Herman of KinderSmile Foundation.

The two dentists shared their efforts to help patients who had been unable to find oral health care until they came to KinderSmile Foundation in dire need of dental intervention.

Says McGrath-Barnes, “Too many times I have witnessed children in marginalized communities suffer from tooth decay, a potentially deadly, yet preventable, disease. Together, by following the recommendations outlined by the Quality Institute and KinderSmile Foundation, we can make a difference in access to oral health care in the state of New Jersey.” 

About the New Jersey Health Care Quality Institute

Carol Ann Campbell represents the New Jersey Health Care Quality Institute’s (Quality Institute).  Its mission is to improve the safety, quality, and affordability of health care for everyone. The membership comes from all stakeholders in health care. Together with our 100 plus members, the Institute says it is working towards a world where all people receive safe, equitable, and affordable health care and live their healthiest lives.