Medicaid Payments and Outcomes for Pediatric Dental Surgical Procedures by Site of Care

Importance: Despite need, children face access barriers to dental surgical procedures. Surgical procedures for older adults delivered in ambulatory surgical centers (ASCs) are less costly than and of comparable quality to care delivered in hospital outpatient departments (HOPDs), but it remains unknown whether this association extends to pediatric dental surgical procedures. Objective: To determine whether payment, time from diagnosis to care, and adverse events for pediatric surgical procedures for dental caries vary between ASCs and HOPDs paid by Medicaid. Design, Setting, and Participants: This cross-sectional study of Medicaid data (July 1, 2016, through January 31, 2020) used an instrumental variables regression approach and exploited a source of exogeneous variation influencing ASC supply. Analysis was conducted October 2024 to April 2025, using records from 29 states with high-quality Medicaid data. Participants were children aged 18 years or younger enrolled in Medicaid who underwent surgical procedures for dental caries in an ASC or HOPD. Exposure: Receipt of dental surgical care in an ASC or HOPD. Main Outcomes and Measures: The primary outcomes were Medicaid payment, days from diagnosis to surgery, and any emergency department visits and hospitalizations within 7 days after surgery. Results: Across 391 628 pediatric dental surgical procedures, patients had a mean (SD) age of 5. 00 (3. 05) years, and 211 819 (54. 09%) were male. Medicaid payment was 604 (95% CI, 149-1058; P <. 009) less for a surgery occurring in an ASC vs an HOPD, corresponding to a 27% reduction in spending, and time from diagnosis to surgery was 8. 9 days (95% CI, 5. 5-12. 3 days; P <. 001) less for a surgery occurring in an ASC than HOPD. A surgery occurring in an ASC (vs HOPD) was statistically significantly less likely to be followed by an emergency department visit or hospitalization within 7 days after surgery (0. 27 percentage points; 95% CI, 0. 18-0. 36 percentage points) and a hospitalization within 30 days after surgery (0. 28 percentage points, 95% CI, 0. 11-0. 45 percentage points). Conclusions and Relevance: In this cross-sectional study of pediatric surgical procedures for dental caries paid by Medicaid, procedures performed in ASCs were less costly and had lower rates of adverse events compared with those performed in HOPDs. The time from diagnosis to surgery was shorter for surgical procedures in ASCs compared with HOPDs, suggesting that ASCs may improve access to care for children from low-income families needing for dental treatment. Increased use of ASCs for pediatric dental surgical procedures may reduce costs for Medicaid and improve patient experiences.