156 - Dental Appointment Availability for Young Children with Medi-Cal Insurance in San Francisco

Abstract:

Purpose: This cross-sectional study evaluated Medi-Cal acceptance, appointment wait times, and language accessibility for children under six years of age among dental clinics listed as Medicaid providers in San Francisco.

Methods: Using a secret shopper methodology, trained callers contacted 83 dental clinics listed in the January 2025 DHCS Medi-Cal Provider Directory. Callers posed as parents seeking dental appointments for a 5-year-old child with visible caries and an 18-month-old child requiring preventive care, both insured through Medi-Cal. Standardized calls were conducted in English, Spanish, and Cantonese. Data collected included Medi-Cal acceptance, acceptance of young children, appointment availability and wait times, reasons for denial, and availability of language interpretation services. Descriptive analyses were conducted, and qualitative call notes were thematically analyzed.

Results: Of the 83 clinics listed, 57 (68.7%) were eligible and contacted, while 26 (31.3%) were ineligible due to closures, inactive numbers, specialty-only practices, or duplicate listings. Reach rates were 56.6% in English, 54.2% in Spanish, and 47.0% in Cantonese. Appointment offer rates in Spanish and Cantonese were less than half of those in English, largely impacted by limited interpretation services. Spanish calls experienced the longest delays, with a mean wait time of 30.8 days. Qualitative themes included age-based denials, behavioral assumptions, negative staff interactions, and operational barriers.

Conclusion: Inaccurate provider directories, limited Medi-Cal participation, and inadequate language access compound barriers to pediatric dental care. Targeted system-level improvements are needed to reduce disparities for young children.