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Raising children in the year 2000 and beyond will be expensive. A review of actual costs by expense categories and a variety of family demographic characteristics provides practitioners with an appreciation of the competitive financial realities faced by many families. An added review of the costs of raising children with disabilities adds further dimension to the financial pressures placed on many families.

The objective of the study was to determine the usefulness of dentists' ranking of Medicaid reimbursement rates as a measure of their participation in the Medicaid program for children. Data were obtained from two mail-in questionnaire surveys of Connecticut dentists, before and after an increase in Medicaid reimbursement rates for children. Dentists ranked acceptability of Medicaid reimbursement rates on a seven-point index, while their participation in the Medicaid program was assessed by whether they acknowledged treating Medicaid children and were currently accepting new Medicaid children into their practices. There was a significant difference (p < 0.0001) in the dentists' ranking of Medicaid reimbursement rates following the rate increase indicating that the index was responsive. Acceptance of new Medicaid children into dental practices was a better measure of active participation in the Medicaid program. Following the increase in Medicaid reimbursement rates, dentists ranking it as acceptable/equivocal were more likely (p < 0.02) to accept new Medicaid children into their practices. In conclusion, the index of dentists' ranking of Medicaid reimbursement rates was a responsive and valid measure of their participation in the Medicaid program.

The number of welfare cases has been halved during this latest period of financial improvement. Can children who are "no longer poor" get dental care? A review of the complex interplay between welfare, Medicaid and dental services is provided.

In an effort to encourage dental practitioners to provide needed services for children with mental retardation as they grow older, a review is provided of the ongoing difficulties faced by families and their children--including attitudes, residence, sibling and older parent dilemmas, cost of care and the realities of sexuality.

In 1997, Congress enacted the State Children's Health Insurance Program to extend health insurance coverage to low-income children who are ineligible for other insurance, including Medicaid. The program is reviewed and considered in terms of children's access to health care and their health status.

The emphasis that managed care programs place on cost containment complicates further the already complex setting for Medicaid health services for children with disabilities by adding an additional barrier to access care to those that already exist. A review considers the attitudes toward and working of Medicaid managed care arrangements for children in general and children with disabilities in particular.

This retrospective longitudinal study analyzed profile and cost of dental services provided to urban low-income (Medicaid) preschool children seeking initial dental care. Clinical and sociodemographic data for Medicaid children, ages five years and under at the time of their first dental visit, were obtained from the dental records of an urban community health center clinic located in a fluoridated area. The sample consisted predominantly of minority children (males = 54; females = 43) who were initially seen during a continuous six-month period in 1991. The children were then observed for a period of one year from the date of first service. At the initial dental visit, the children had a mean age of 3.7 years and dmft of 4.4 with two-thirds of them exhibiting dental caries. The children made an average of 2.3 visits with more than two-fifths of them receiving at least one treatment service during the year. Children four years of age and older at the initial visit, had greater caries prevalence, higher mean dmft, made more dental visits and incurred greater annual expenditure. Greater proportion of females and older children (> or = 4 years) received restorations and extractions. It is concluded that treatment for dental caries is a significant dental service provided to urban low-income (Medicaid) preschool children seeking initial dental care. The results of this study suggest that preschool programs should target these children and promote an initial dental visit before four years of age particularly among females.

Each year thousands of poor children with disabilities "age out" of dental programs that were established to meet their needs. But now they are older. Most states provide minimal if any dental services (with limited reimbursement levels) for adults within the Medicaid system. In an effort to stimulate an awareness of these difficulties, a review is provided of 1) the number of the "former" children with disabilities who are faced with the unavailability of dental services and 2) the limitations of the adult Medicaid dental program.

Costs of raising children continue to rise. At the same time, the marked increase in the proportion of two-earner families and single-parent families places added burdens on families to develop and pay for child care arrangements. A review is provided of current and anticipated financial costs of raising children during the 1990s and planning for the finances of their future years.

In light of a federal report on the extremely limited availability of preventive dental services for children under the Medicaid program, a review is provided of the evolving comparative share of general health expenditures and Medicaid funds that are spent on dental services. The findings indicate that during the 1990s, dentistry in general and within the Medicaid program occupies a continuing decreasing share of expenditures.

Bureau of the Census projections for the next decades indicated dramatic increases in the numbers of minority children in our population and actual decreases in the numbers of non-Hispanic white children. A summary of these projections is provided.

The author reviews the personal problems faced by children in single-parent and divorced-parent households, emphasizing the altered economic realities accompanying the dissolution of a marriage or the birth of a child to an unwed mother.

To determine the prevalence of infant caries in low-socioeconomic-status children and to analyze the costs of their treatment, we retrospectively evaluated 357 children, ages eight months to seven years, who were treated during 1992 at a university-associated medical center in Northern California. Infant caries was diagnosed by several different standards, and prevalence varied according to the diagnostic criteria employed: 27 percent by the presence of any labiolingual lesion on the maxillary incisors; 32 percent by the presence of at least two carious maxillary incisors; 27 percent by the presence of at least three carious maxillary incisors; and 36 percent by a dmft > or = 5. Prevalence was higher among boys than girls (37 percent versus 27 percent), and highest in the group ages 3-4 years (43 percent). The cost of dental treatment increased with deft and ranged from $408 for deft 2-5 to $1725 for deft 16-20. Many patients failed to comply with recommended treatment for reasons of cost. Our results showed that (1) the prevalence of infant caries varies depending upon the clinical criteria used for diagnosis; (2) the cost of rehabilitating primary dentition increases in proportion to the number of teeth involved; and (3) low-income patients avoid treatment of infant caries for a variety of reasons related to the cost involved.

A general outline of the Aid to Families with Dependent Children program is provided. The $22 billion program provides financial support to 14 million persons (including more than 9 million children). The changing character of the family structure is considered in terms of efforts to control AFDC spending. Additional programs to assist children (Social Security, Supplemental Security Insurance and Food Stamps) are reviewed.