Provision of Fluoride Varnish to Medicaid-Enrolled Children by Physicians: The Massachusetts Experience

UMMS Affiliation

Department of Family Medicine and Community Health; Department of Quantitative Health Sciences; Center for Healh Policy and Research

Publication Date


Document Type



Fluorides, Topical; Medicaid; Dental Care for Children; Preventive Dentistry; Physicians, Primary Care; Insurance, Health, Reimbursement; Massachusetts


Community Health and Preventive Medicine | Dentistry | Preventive Medicine | Primary Care


Objectives. To evaluate the impact of a 2008 Medicaid policy in Massachusetts (MA), regarding reimbursing physicians for providing fluoride varnish (FV) to eligible children in medical settings.

Data Source. Survey of a sample of primary care physicians in MA.

Study Design. Cross-sectional survey of a sample of physicians who provide care to MassHealth (MA Medicaid) enrolled-children. Dependent variables: history of completed preventive dental skills training, and FV provision. Independent variables: oral health knowledge, FV-attitudes, and physician and practice characteristics.

Principal Findings. Overall, 19 percent of respondents had completed the training required to be eligible to bill for FV provision. Only 5 percent of physicians were providing FV. Most respondents (63 percent) were not familiar with the new policy, and only 25 percent felt that FV should be provided during well-child visits. Most physicians (60 percent) did not feel that the reimbursement rate of U.S.$26/application was sufficient; 17 percent said that they would not provide FV, regardless of payment. Most common barriers to FV provision were a lack of time and logistical challenges.

Conclusions. Our findings suggest that simply reimbursing physicians for FV provision is insufficient to ensure provider participation. Success of this policy will likely require addressing several barriers identified.

DOI of Published Version



Isong, I. A., Silk, H., Rao, S. R., Perrin, J. M., Savageau, J. A. and Donelan, K. (2011), Provision of Fluoride Varnish to Medicaid-Enrolled Children by Physicians: The Massachusetts Experience. Health Services Research, 46: 1843–1862. doi: 10.1111/j.1475-6773.2011.01289.x

Journal/Book/Conference Title

Health Services Research

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Link to article in PubMed

PubMed ID