Purpose: The purposes of this survey were to assess barriers to utilization of dental services among Medicaid-enrolled Alabama children and identify families who used or did not use Medicaid-covered dental services. Methods: A random sample of 4,500 parents of Medicaid-eligible children ages 3 to 19 years was surveyed. Participants came from Medicaid enrollment data stratified by area of residence into 3 groups: (1) large urban; (2) town; and (3) rural. Univariate and multivariate analyses were conducted. Results: The overall response rate was 40% (N= 1,766). Most respondents (71 %) reported that their child had a dental visit in the past year. Compared to parents who had a dental visit, those who reported no visits were more likely to: (1) be non-Hispanic African American; (2) be less educated; (3) live in rural settings of Alabama; (4) have more children younger than 6 or older than 12; (5) have more children with disabling conditions; and (6) report poor perceived oral health. Respondents with no dental visits were grouped into 3 categories - those who: (1) believed they did not need dental care (46%); (2) thought dental care was hard to find (34%); and (3) tried but could not get dental care (20%). The first group had significantly less respondents with a high school or greater education, more reporting perceived good to excellent oral health, and more living in rural areas, compared to the other 2 groups. Conclusions: Families who did not use Medicaid-covered dental services include: (1) a group with high perceived need and barriers to care; and (2) a group with little perceived need. Interventions must target both groups.