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Reynolds JC, Comnick C, Heeren T, Xie XJ, Damiano PC. Medicaid Dental Benefits for Pregnant People and Dental Care Use Among Very Young Children. Matern Child Health J 2024; 28:1604-1611. [PMID: 38918313 DOI: 10.1007/s10995-024-03955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVES The aim of this study was to examine the association between Medicaid dental benefits for pregnant people and dental care use among very young children in Medicaid. We hypothesized that children living in states with more generous dental benefits for Medicaid-enrolled pregnant people would be more likely to have a recent dental visit. METHODS This national cross-sectional study used pooled 2017-2019 data from the National Survey of Children's Health, as well as state Medicaid policy data. The study sample included children aged 0-2 enrolled in Medicaid. Multivariable logistic regression models estimated the association between Medicaid dental benefit generosity for pregnant people and the child having a dental visit in the past year. RESULTS Children in states with emergency-only dental coverage for pregnant people were 2.5 times as likely to have had a dental visit than children in states with extensive coverage (OR 2.48, 95% CI 1.35-4.53). In supplemental analyses excluding children living in Texas, there was no longer an association between dental coverage for pregnant people and dental utilization among young children (OR 1.52, 95% CI 0.82-2.83). CONCLUSIONS FOR PRACTICE Young children in states that provided emergency-only dental benefits for pregnant people in Medicaid had significantly higher odds of dental utilization than young children in states with more generous dental benefits for pregnant people. This relationship disappeared after excluding the state Texas, which had the highest rate of child dental utilization in the country and provided emergency-only dental benefits for pregnant people in Medicaid.
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Affiliation(s)
- Julie C Reynolds
- University of Iowa College of Dentistry, Iowa City, IA, 52242, USA.
| | - Carissa Comnick
- University of Iowa College of Dentistry, Iowa City, IA, 52242, USA
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Tessa Heeren
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Xian Jin Xie
- University of Iowa College of Dentistry, Iowa City, IA, 52242, USA
| | - Peter C Damiano
- University of Iowa College of Dentistry, Iowa City, IA, 52242, USA
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Mommaerts K, Roy I, Helm DM. Impact of the COVID-19 pandemic on pediatric Medicaid dental claims in Arizona. J Public Health Dent 2023; 83:239-246. [PMID: 37046370 DOI: 10.1111/jphd.12572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 02/17/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To examine the role COVID-19 had on access to dental services among children in Arizona by comparing paid pediatric dental claims made before and during the pandemic. METHODS In a retrospective descriptive study, we examined Medicaid paid claims for dental services among pediatric patients from March through December 2019 and during the outbreak in 2020. Using dental claims data obtained from the Centers for Health Information and Research at Arizona State University (ASU), we analyzed Medicaid (Arizona Health Care Cost Containment System [AHCCCS]) reimbursed dental services. RESULTS During the COVID-19 pandemic, paid preventive dental claims for children aged birth to 21 years decreased in 2020 compared to the same time period in 2019. Pediatric patients in Arizona utilized fewer dental services and had less access to credentialed Medicaid dental providers during the pandemic. Further, rural counties had statistically significant fewer preventive, minor restorative, major restorative, and endodontic claims compared to urban counties. Arizona rural counties also had fewer providers who were paid $10,000 or more per year during 2020 than in 2019. CONCLUSIONS COVID-19 has had a detrimental impact on pediatric dental service utilization. While dental services were provided during the COVID-19 pandemic, preventive and restorative dental claims dropped for rural Arizona children aged birth to 21 years. This reveals potential negative impacts on oral health. Further research should examine the direct and indirect impact the COVID-19 pandemic has had on dental service utilization and oral health for the general pediatric population.
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Affiliation(s)
- Katherine Mommaerts
- Department of Social Work, Northern Arizona University, Flagstaff, Arizona, USA
| | - Indrakshi Roy
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Denise Muesch Helm
- Department of Dental Hygiene, Northern Arizona University, Flagstaff, Arizona, USA
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Kusma JD, Cartland J, Davis MM. State-Level Managed Care Penetration in Medicaid and Rates of Preventive Care Visits for Children. Acad Pediatr 2021; 21:1338-1344. [PMID: 33607329 DOI: 10.1016/j.acap.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine time trends in receipt of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services in serial cohorts of Medicaid beneficiaries <21 years, as Medicaid managed care (MMC) was adopted by states. METHODS Using annual state-level data from the Centers for Medicare & Medicaid Services, we performed national analyses of Medicaid beneficiaries <21 years from 2000 to 2017. We used generalized linear models to assess the relationship between MMC enrollment and EPSDT encounters, accounting for repeated measures, first at the national level overall and then specifying random effects at the state level. RESULTS From 2000 to 2017, there was an increase at the national level in Medicaid beneficiaries <21 years enrolled in MMC, from 65% to 94%. At the national level, for every additional 100 enrollees in MMC there was an associated increase of 36 beneficiaries with an EPSDT visit (95% confidence interval: 19-53; P < .001). When accounting for state-level variation, for every additional 100 enrollees in MMC, there was an increase of 6 beneficiaries with an EPSDT visit (95% confidence interval: 2-10; P = .003). Examining the association between MMC penetration and EPSDT participation within each state, including the 50 states and Washington DC, there were 17 states with a significant positive association between MMC ratio and EPSDT participation, and 6 states with a significant negative association. CONCLUSIONS As managed care has become the predominant form of Medicaid coverage, there has been a modest increase in preventive visits as indicated by EPSDT participation, with marked variation across states.
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Affiliation(s)
- Jennifer D Kusma
- Division of Advanced General Pediatrics and Primary Care, Mary Ann & J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago (JD Kusma and MM Davis), Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine (JD Kusma, J Cartland, and MM Davis), Chicago, Ill.
| | - Jenifer Cartland
- Department of Pediatrics, Northwestern University Feinberg School of Medicine (JD Kusma, J Cartland, and MM Davis), Chicago, Ill; Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago (J Cartland), Chicago, Ill
| | - Matthew M Davis
- Division of Advanced General Pediatrics and Primary Care, Mary Ann & J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago (JD Kusma and MM Davis), Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine (JD Kusma, J Cartland, and MM Davis), Chicago, Ill; Departments of Medicine, Medical Social Sciences, and Preventive Medicine, Northwestern University Feinberg School of Medicine (MM Davis), Chicago, Ill
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The impact of dental Medicaid reform on dental care provider activity and market penetration of dental support organizations. J Am Dent Assoc 2021; 152:822-831. [PMID: 34454708 DOI: 10.1016/j.adaj.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/14/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Medicaid state dental programs have experienced changes related to provider practice settings with the increased growth of dental support organizations (DSOs). The authors conducted this study to assess the impact of state Medicaid reform on the dental practice environment by examining provider activity and practice setting. METHODS This was a retrospective cohort study of more than 13 million dental claims in the Virginia Medicaid program. It included children and dental care providers in the Virginia dental Medicaid program at some time during a 9-year period (fiscal years 2003-2011). The independent variable was the provider practice setting: private practice, DSO, and safety-net practice. The outcomes included annual measures of claims, patients, and payments per provider. The outcomes were examined over 3 phases of the study period: prereform (2003-2005), implementation phase (2006-2008), and postreform maturation (2009-2011). RESULTS Provider activity increased after dental program reform, with private-practice providers delivering most of the dental care in the Medicaid program. There was a significant penetration of DSO providers in number of providers, claims per provider, and patients per provider (P < .001). Regression results found that providers in DSO settings had an increased number of patients and claims compared with private-practice providers. CONCLUSIONS Medicaid reform has resulted in a significant increase in provider participation and growth of DSO-affiliated providers. PRACTICAL IMPLICATIONS Areas of the state with more dense population had a higher penetrance of dentists practicing in DSO settings providing dental services to children enrolled in Medicaid.
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Claiborne DM, Kelekar U, Shepherd JG, Naavaal S. Emergency department use for nontraumatic dental conditions among children and adolescents: NEDS 2014-2015. Community Dent Oral Epidemiol 2021; 49:594-601. [PMID: 33755217 DOI: 10.1111/cdoe.12631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 01/13/2021] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Despite great efforts to improve paediatric dental care access in the last two decades, the use of emergency departments (ED) for dental conditions among children that are more appropriately addressed in dental offices remains a public health concern in the United States. We examined factors associated with ED visits for nontraumatic dental conditions or NTDCs and ED visits for any other reason among children and adolescents. METHODS A retrospective secondary data analysis of ED visits was conducted using the 2014-2015 Nationwide Emergency Department Sample (NEDS) data. NTDCs were further categorized as diseases of hard tissue (eg dental caries), pulp/periapical (eg root canal infections), gingival/periodontal (eg conditions that affect the supporting tissues) and other. We included patient/socioeconomic characteristics, disposition, time of visit, and the Grouped Charlson Comorbidity Index (GRPCI) in our analysis. Bivariate associations were tested using chi-squared test (α = 0.05). RESULTS There were 70 616 194 ED visits in 2014-15, with 465 353 (0.7%) visits for NTDCs. Statistically significant differences were observed for all patient characteristics tested, except for gender when comparing children visiting the ED for NTDCs and children visiting for any other reason. Medicaid was the expected payer for nearly 60% of all ED visits, and the uninsured shared a larger proportion of NTDC visits (19.4%) than other visits (8.8%). Late adolescents (aged 18-21) accounted for over 50% of NTDC visits but only one-fifth of all other types of ED visits. Late adolescents (18-21 years old) who were uninsured had a significantly higher proportion of NTDC visits. Of all NTDC visits, 19.1% were related to hard tissue disease, 25.3% pulp/periapical, 7.9% periodontal disease, and the remaining were grouped as other dental diseases. CONCLUSIONS The ED use for NTDCs is more common among late adolescents, Medicaid and uninsured groups. Examining and implementing new approaches that improve access to routine dental care for these groups may help in reducing inefficient ED use related to NTDCs.
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Affiliation(s)
- Denise M Claiborne
- Gene W. Hirschfeld School of Dental Hygiene, Old Dominion University, Norfolk, VA, USA
| | - Uma Kelekar
- School of Business, Innovation, Leadership and Technology, Marymount University, Arlington, VA, USA
| | | | - Shillpa Naavaal
- Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA.,Oral Health in Childhood and Adolescence Core, Institute for Inclusion, Inquiry and Innovation, Virginia Commonwealth University, Richmond, VA, USA
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Lee HH, Faundez L, Nasseh K, LoSasso AT. Does Preventive Care Reduce Severe Pediatric Dental Caries? Prev Chronic Dis 2020; 17:E136. [PMID: 33119483 PMCID: PMC7665577 DOI: 10.5888/pcd17.200003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Tertiary oral health services (caries-related surgery, sedation, and emergency department visits) represent high-cost and ineffective ways to improve a child's oral health. We measured the impact of increased Texas Medicaid reimbursements for preventive dental care on use of tertiary oral health services. METHODS We used difference-in-differences models to compare the effect of a policy change among children (≤9 y) enrolled in Medicaid in Texas and Florida. Linear regression models estimated 4 outcomes: preventive care dental visit, dental sedation, emergency department use, and surgical event. RESULTS Increased preventive care visits led to increased sedation visits (1.7 percentage points, P < .001) and decreased emergency department visits (0.3 percentage points, P < .001) for children aged 9 years or younger. We saw no significant change in dental surgical rates associated with increased preventive dental care reimbursements. CONCLUSION Increased access to preventive dentistry was not associated with improved long-term oral health of Medicaid-enrolled children. Policies that aim to improve the oral health of children may increase the effectiveness of preventive dentistry by also targeting other social determinants of oral health.
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Affiliation(s)
- Helen H Lee
- Department of Anesthesiology, College of Medicine, University of Illinois at Chicago, 1740 W Taylor St, Ste 3200W, MC 515, Chicago, IL 60612.
| | - Luis Faundez
- Department of Economics, University of Illinois at Chicago, Chicago, Illinois
| | - Kamyar Nasseh
- Health Policy Institute, American Dental Association, Chicago, Illinois
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Blackburn J, Bennett A, Fifolt M, Rucks A, Taylor H, Wolff P, Sen B. Pediatric dental care use and parent- or caregiver-rated oral health among Alabama children enrolled in Medicaid. J Am Dent Assoc 2020; 151:416-426. [PMID: 32450980 PMCID: PMC9743449 DOI: 10.1016/j.adaj.2020.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Reducing caries and improving access to dental care is a public health challenge. Understanding low use of dental care is of critical importance. This study estimated parent- or caregiver-reported prevalence and identified factors associated with children's dental care use, including the association with children's oral health. METHODS A cross-sectional analysis of children enrolled in Medicaid in Alabama, using data from the 2017 statewide Consumer Assessment of Healthcare Providers and Systems Health Plan Survey, was conducted. Associations were measured using adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) from logit regression and generalized linear model postestimation of least-squares means. RESULTS The 6-month prevalence of children receiving dental care was 70.4%. Children aged 0 through 3 years (aPR, 0.72; 95% CI, 0.53 to 0.91) had lower prevalence of care than other age groups. The prevalence of low-rated oral health was 9.2%. Low-rated oral health was associated with not receiving dental care (aPR, 1.50; 95% CI, 1.12 to 1.87) and parental education of 8th grade or less (aPR, 2.59; 95% CI, 1.20 to 3.98). Falsification tests determined that dental care use was not associated with ratings for overall health (aPR, 1.18; 95% CI, 0.83 to 1.52) or emotional health (aPR, 1.06; 95% CI, 0.79 to 1.33). CONCLUSIONS It was observed that children not receiving dental care had low-rated oral health; however, as a cross-sectional study, it was not possible to assess the temporality of this relationship. PRACTICAL IMPLICATIONS Oral health care providers should continue to recognize their role in educating parents and providing anticipatory guidance on children's oral health.
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Affiliation(s)
| | - Aleena Bennett
- University of Alabama at Birmingham School of Public Health
| | - Matt Fifolt
- University of Alabama at Birmingham School of Public Health
| | - Andrew Rucks
- University of Alabama at Birmingham School of Public Health
| | - Heather Taylor
- Indiana University Richard M. Fairbanks School of Public Health
| | - Paul Wolff
- University of Alabama at Birmingham School of Public Health
| | - Bisakha Sen
- University of Alabama at Birmingham School of Public Health
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