AbstractObjectivesTo identify factors associated with dental utilization and expenditures for children enrolled in Washington State (WA) foster care (FC).MethodsThis cross‐sectional study used 2008 Medicaid enrollment and claims files for children ages <18 years enrolled in the WA FC program for ≥11 months (N = 10,177). Regression models were used to examine associations between utilization and expenditures and sex, race, age group, Supplemental Security Income (SSI) (i.e., disability), substance abuse, behavior problems, placement setting (Foster Home Care, Kinship Care, Group Care, Other), and urbanicity.ResultsOnly 43 percent of the children utilized any dental care; the adjusted mean expenditure was $198.35 [95% confidence interval (CI) $181.35, $215.36]. Fewer utilized diagnostic (41 percent), preventive (39 percent), restorative (11 percent), or complex (5 percent) services. Associated with utilization (P ≤ 0.01) were: female [ARR = 1.05, 95% CI(1.01, 1.10)]; 0‐2 years [ARR = 0.18, 95% CI(0.15, 0.21)], [3‐5 years ARR = 0.78, 95% CI(0.74, 0.83)]; Native American [ARR = 0.85, 95% CI(0.80, 0.91)]; SSI [ARR = 1.10, 95% CI(1.04, 1.17)]; Kinship Care [ARR = 0.94, 95% CI(0.90, 0.98)]; Group Care [ARR = 1.25 95% CI(1.15, 1.37)]; and urban/rural urbanicity with population <20 K [ARR = 1.20 95% CI(1.12, 1.30)]. Associated with expenditures (P < 0.05) were: ages 0‐2 years [–$153.66, 95% CI(–$168.33, –$139.00)], 3‐5 years [–$98.71, 95% CI(–$116.78, –$80.65)], 6‐11 years [–$16.83 95% CI(–$33.52, –$0.14)]; African American [–$32.05 95% CI(–$47.99, –$16.12)]; Kinship Care [$28.57 95% CI($14.00, $43.15)].ConclusionsMost children enrolled in WA FC for ≥11 months during 2008 did not receive dental care. Research is needed to determine the level of unmet need among children in FC and interventions to improve access to oral health of the children. Enforcement of existing federal legislation is needed.