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Background: Public dental insurance programs for children aim to provide access to care, but barriers remain that preclude care delivery. Understanding these barriers is an important health policy concern., Methods: A telephone audit sought to ascertain availability of oral health care for children in dental offices eligible to bill Medicaid. Female callers posing as mothers called eligible offices requesting appointments. In this cross-over design, offices were randomized to public or private insurance for initial calls and then to the other condition after a washout period., Results: Using mixed models, privately insured patients had 5.9 times (95% CI, 4.55 to 7.69) greater odds of obtaining an appointment than Medicaid patients. Compared with patients in Cook County, suburban patients had slightly better odds, whereas nonurban patients in larger and smaller rural counties had lower odds of success., Conclusions: Medicaid compares poorly with private insurance for providing access to pediatric oral health care. Regardless of insurance conditions, access is poor in less urban environments compared with metropolitan communities., Practical Implications: Even Medicaid-enrolled dental practices limit the care they extend to insured children. Providing Medicaid by itself cannot overcome large oral health care access disparities, which are greatest in rural communities., (Copyright © 2023 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Structural racism negatively affects the health of Black populations in the U.S. Black populations experience a higher burden of oral diseases, such as tooth decay, periodontal disease, and oral and pharyngeal cancers than other racial groups experience. Oral health literature refers to racial inequities in the context of social disadvantage. However, structural racism perpetuates those contributory social disadvantages, such as inadequate access to affordable housing, education, and employment. In addition, in states where nearly 50% of U.S. Black populations reside, there is an inequitable distribution of adult Medicaid dental benefits as well as an inequitable availability of both Black and non-Black oral health care providers. Addressing structural racism in oral health should involve commitment among stakeholders to establish awareness and equity through community-building, policy, oral health workforce development, and research. [ABSTRACT FROM AUTHOR]