Association for Public Policy Analysis & Management

In this study, we examine Virginia’s Smiles for Children—a dental benefit program for state residents recently expanded to administer dental services for uninsured pregnant, and recently postpartum, women. Despite the literature detailing the linkages between oral health and pregnancy outcomes—including maternal oral health—little is known about attempts, successes, and challenges to obtaining covered services from the beneficiaries’ perspectives. Drawing from a health services utilization framework and an inductive exploration of participants’ experiences, this study focuses on low-income women eligible to receive benefits in the Richmond metropolitan area of Virginia. We collected semi-structured face-to-face interviews with 14 participants; transcribed each verbatim; and conducted thematic analysis using a combination of deductive and inductive coding schemes.

Barriers to utilization identified include: access challenges to dental treatment providers; the limited duration between learning of the benefit and coverage termination; and competing needs faced by women between infant care and their own postpartum health concerns. Factors found to facilitate use of the dental benefits included: social support resources including family and healthcare providers; knowledge of unmet dental needs and treatment options; and public benefit coverage for needed treatment. We conclude with participants’ recommendations on strengthening the program by educating beneficiaries about dental coverage as early in their eligibility as possible; improving provider acceptance of beneficiaries as patients; and extending the benefit’s duration. Findings of this investigation provide insight into barriers and guide enhanced participation and utilization of other national and subnational dental benefit programs.