Impact of a Medicaid Policy on Preventive Oral Health Services for Children with Intellectual Disabilities, Developmental Disabilities, or Both

Published in: The Journal of the American Dental Association, Volume 151, Issue 4, pages 255–264.e3 (April 2020). doi: 10.1016/j.adaj.2019.12.001

Posted on RAND.org on February 12, 2021

by Ashley M. Kranz, Rachel Ross, Mark J. Sorbero, Aaron Kofner, Bradley D. Stein, Andrew W. Dick

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Background

Integrating preventive oral health services (POHS) into medical offices may ease access to care for children with intellectual and developmental disabilities (IDD). The authors examined the impact of state policies allowing delivery of POHS in medical offices on receipt of POHS among Medicaid enrollees with IDD.

Methods

The authors used 2006 through 2014 Medicaid data for children with IDD aged 6 months through 5 years from 38 states. IDD were defined using 14 condition codes from Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse. The length of the state's medical POHS policy (no policy, < 1 year, 1 year, 2 years, 3 years, or ≥ 4 years) was interacted with an indicator that the child was younger than 3 years. The authors used logistic regression models to estimate the likelihood that a child received POHS in a medical office or in a medical or dental office in a given year.

Results

Among 447,918 children with IDD, 1.6% received POHS in medical offices. Children younger than 3 years in states with longer-enacted policies had higher rates of receiving POHS. For example, the predicted probability of receiving POHS was 40.6% (95% confidence interval, 36.3% to 44.9%) for children younger than 3 years in states with a medical POHS policy for more than 4 years compared with 30.6% (95% confidence interval, 27.8% to 33.5%) for children in states without a policy.

Conclusions

State Medicaid policies allowing delivery of POHS in medical offices increased receipt of POHS among Medicaid-enrolled children with IDD who were younger than 3 years.

Practical Implications

Few children with IDD receive POHS in any setting. Efforts are needed to reduce barriers to POHS for publicly insured children with IDD.

Research conducted by

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