This research sought to determine the comparative influence of four state-related variables—Medicaid funding rates, extent of Medicaid adult dental benefits (MADB), dentist enrollment in Medicaid, and availability of dental professionals—on the engagement with dental services among Medicaid-covered children and adolescents aged 1 to 17. Employing a cross-sectional national dataset from the 2018 to 2019 National Survey of Children's Health, this study analyzed dental care participation among Medicaid-enrolled youth. Age-stratified subgroup analyses were performed. A sequential logistic regression approach evaluated the relative impact of the four state-level factors on dental care usage. For the overall cohort aged 1 to 17 and the 1 to 3 age subgroup, dentist involvement in Medicaid programs showed a positive association with dental service utilization. Among children aged 4 to 11, those in states with no or emergency-only adult dental coverage had a higher probability of dental visits compared to peers in states with full coverage. For adolescents aged 12 to 17, no state-level variables were linked to dental care engagement. The study revealed substantial age-based differences in how state-level factors affect dental service use among Medicaid-enrolled youth. Dentist participation in Medicaid was notably critical for dental care access among the youngest children. State-level policy mechanisms hold significant promise for enhancing dental care access for Medicaid-covered children, playing an essential role in promoting equitable oral health outcomes for this population.
