Abstract
Objective To determine if Medicaid eligibility is associated with unmet preventive dental care need for Medicaid-enrolled CSHCN. Methods We analyzed the 2009–2010 National Survey of CSHCN and focused on Medicaid-enrolled children ages 3–17. The outcome measure was parent-reported unmet need for preventive dental care. The predictor variable was state Medicaid eligibility criteria, categorized as broad [>250 % Federal Poverty Level (FPL)], moderate (200–249 % FPL), and narrow (<200 % FPL). Multiple variable multilevel logistic regression models estimated the association between state-level eligibility criteria and variability in unmet need. Results The multilevel models indicated no significant association between Medicaid eligibility criteria and unmet preventive dental care need. CSHCN with more severe chronic health conditions had significantly greater odds of unmet need (OR 1.52; 95 % CI 1.28, 1.82) and CSHCN with a medical home had significantly lower odds (OR 0.61; 95 % CI 0.50, 0.75). Conclusions for practice There is significant state variability in unmet need for preventive dental care for Medicaid-enrolled CSHCN. Broadening Medicaid eligibility criteria alone is not likely to address the preventive dental care needs of CSHCN, which has policy implications for improving oral health disparities for publicly-insured CSHCN.
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Abbreviations
- ACA:
-
Patient Protection and Affordable Care Act
- MLM:
-
Multilevel model
- NS-CSHCN:
-
National Survey of Children with Special Health Care Needs
References
American Academy of Pediatric Dentistry Clinical Affairs Committee, & American Academy of Pediatric Dentistry Council on Clinical Affairs. (2009). Guideline on periodicity of examination, preventive dental services, anticipatory guidance, and oral treatment for children. Pediatric Dentistry, 30(suppl 7), 112–118.
US Department of Health and Human Services. (2000). Oral health in America: A report of the surgeon general. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research National Institute of Health.
Kenney, M. K. (2009). Oral health in CSHCN: State medicaid policy considerations. Pediatrics, 124, S384–S391.
Lai, B., Milano, M., Roberts, M. W., & Hooper, S. R. (2012). Unmet dental needs and barriers to dental care among children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42, 1294–1303.
Ngui, E. M., & Flores, G. (2007). Unmet needs for specialty, dental, mental, and allied health care among children with special health care needs: Are there racial and ethnic disparities? Journal of Health Care for the Poor and Underserved, 18(4), 931–949.
Lewis, C., Robertson, A. S., & Phelps, S. (2005). Unmet dental care needs among children with special health care needs: Implications for the medical home. Pediatrics, 116, e426–e431.
Bethell, C., Reed, D., Stein, R., Blumberg, S., Wells, N., & Newacheck, P. (2002). Identifying children with special health care needs: Development and evaluation of a short screening instrument. Ambulatory Pediatrics, 2, 38–48.
Chi, D. L., McManus, B. M., & Carle, A. C. (2013) Caregiver burden and preventive dental care use for US children with special health care needs: A stratified analysis based on functional limitation. Maternal and Child Health Journal (epub ahead of print).
Data Resource Center for Child and Adolescent Health. Health insurance coverage and program participation. Accessed from http://www.childhealthdata.org/browse/survey/results?q=1810&r=1. 22 May 2014.
Chi, D. L., Momany, E., Neff, J., Jones, M., Warren, J., Slayton, R., et al. (2011). Impact of chronic condition status and severity on dental utilization for Iowa Medicaid-enrolled children. Medical Care, 49(2), 180–192.
Davis, M. J. (2000). American academy of pediatric dentistry task, force on work force issues. Pediatric dentistry workforce issues: A task force white paper. Pediatric Dentistry, 22, 331–335.
Milano, M., & Seybold, S. V. (2002). Dental care for special needs patients: A survey of Texas pediatric dentists. ASDC Journal of Dentistry for Children, 69, 212–216.
Patrick, D., Lee, R., Nucci, M., et al. (2006). Reducing oral health disparities: A focus on social and cultural determinants. BMC Oral Health, 6(suppl 1), S4.
Chi, D. L., Momany, E. T., Neff, J., Jones, M. P., Warren, J. J., Slayton, R. L., et al. (2011). Impact of chronic condition status and severity on dental utilization for Iowa Medicaid-enrolled children. Medical Care, 49, 180–192.
Data Resource Center for Child and Adolescent Health. 2009–2010 National Survey of Children with Special Health Care Needs. Retrieved from www.childhealthcata.org
Ross, D. C., Jarlenski, M., Artiga, S., & Marks, C. (2009). A foundation for health reform: Findings of a 50 state survey of eligibility rules, enrollment and renewal procedures, and cost sharing practices in medicaid and CHIP for children and parents during 2009. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8028.pdf
Data Resource Center. Quantifying the medical home concept. Excerpt from measuring medical home: A resource manual for Researchers and Analysts. http://www.childhealthdata.org/docs/medical-home/mh_manual_quantify-pdf.pdf
Subramanian, S., & Jones, K. (2002). Multilevel statistical models: Concepts and applications. Boston, MA: Center for Society and Health, Harvard School of Public Health/Bristol: Centre for Multilevel Modeling, University of Bristol.
Carle, A. (2009) Fitting multilevel models in complex survey data using design weights: Recommendations. BMC Medical Research Methodology, 9:49. doi:10.1186/1471-2288-9-49. Accessed 3 October 2009.
SAS v9.13. Copyright 2002–2003 by SAS Institute Inc., Cary, NC, USA.
Muthen, L. K., & Muthen, B. O. (1998–2007). Mplus user’s guide (6th ed.). Los Angeles, CA: Muthen and Muthen.
Currie, J., & Grogger, J. (2002). Medicaid expansions and welfare contractions: Offsetting effects on prenatal care and infant health? Journal of Health Economics, 21(2), 313–335.
Mayer, M. L., Stearns, S. C., Norton, E. C., & Rozier, R. G. (2000). The effects of Medicaid expansions and reimbursement increases on dentists’ participation. Inquiry, 37(1), 33–44.
Howell, E. M., & Kenney, G. M. (2012). The impact of Medicaid/CHOP expansions on children: A synthesis of the evidence. Medical Care Research and Review, 69(4), 372–396.
Davidson, G., Blewett, L. A., Call, K. T., & Williams, C. H. (2004). Public program crowd-out of private coverage. The Synthesis Project: Research Synthesis Report No. 5. www.shadac.org/sites/default/files/Old_files/Crowdout_Brief_Jun04.pdf.
Kobayashi, M., Chi, D., Coldwell, S. E., Domoto, P., & Milgrom, P. (2005). The effectiveness and estimated costs of the access to baby and child dentistry program in Washington State. Journal of the American Dental Association, 136(9), 1257–1263.
Pahel, B. T., Rozier, R. G., Stearns, S. C., & Quiñonez, R. B. (2011). Effectiveness of preventive dental treatments by physicians for young Medicaid enrollees. Pediatrics, 127(3), e682–e689.
Casaverde, N. B., & Douglass, J. M. (2007). The effect of care coordination on pediatric dental patient attendance. Journal of Dentistry for Children (Chicago), 74(2), 124–129.
Brickhouse, T. H., Haldiman, R. R., & Evani, B. (2013). The impact of a home visiting program on children’s utilization of dental services. Pediatrics, 132(Suppl 2), S147–S152.
Parish, S. L., Rose, R. A., Yoo, J., & Swaine, J. G. (2012). State Medicaid policies and the health care access of low-income children with special health care needs living in the American South. North Carolina Medical Journal, 73(1), 15–23.
Decker, S. L. (2011). Medicaid payment levels to dentists and access to dental care among children and adolescents. JAMA, 306(2), 187–193.
McManus, B. M., McCormick, M. C., Acevedo-Garcia, D., Ganz, M., & Hauser-Cram, P. (2009). The effect of state early intervention (EI) eligibility on EI participation among children with special health care needs. Pediatrics, 124, S368–S374.
Lewis, C. W. (2009). Dental care and children with special health care needs: A population-based perspective. Academic Pediatric, 9(6), 420–426.
Yu, S. M., Nyman, R. M., Kogan, M. D., Huang, Z. J., & Schwalberg, R. H. (2004). Parent’s language of interview and access to care for children with special health care needs. Ambulatory Pediatrics, 4(2), 181–187.
Ngui, E. M., & Flores, G. (2007). Unmet needs for specialty, dental, mental, and allied health care among children with special health care needs: Are there racial/ethnic disparities? Journal of Health Care for the Poor and Underserved, 18(4), 931–949.
Strickland, B. B., Jones, J. R., Ghandour, R. M., Kogan, M. D., & Newacheck, P. W. (2011). The medical home: Health care access and impact for children and youth in the United States. Pediatrics, 127(4), 604–611.
Chi, D. L. (2014). Medical care transition planning and dental care use for youth with special health care needs during the transition from adolescence to young adulthood: A preliminary explanatory model. Maternal and Child Health Journal, 18(4), 778–788.
Crowley, R. A., & Golden, W. (2014). Health policy basics: Medicaid expansion. Annals of Internal Medicine, 160(6), 423–425.
Chi, D. L., Momany, E. T., Kuthy, R. A., Chalmers, J. M., & Damiano, P. C. (2010). Preventive dental utilization for Medicaid-enrolled children in Iowa identified with intellectual and/or developmental disability. Journal of Public Health Dentistry, 70(1), 35–44.
Author Contributions
Beth McManus: Dr. McManus conceptualized and designed the study (with Dr. Chi), conducted the analyses, drafted the initial manuscript, and approved the final manuscript as submitted. Donald Chi: Dr. Chi conceptualized and designed the study with Dr. McManus, revised multiple manuscript drafts, and approved the final manuscript as submitted. Adam Carle: Dr. Carle revised manuscript drafts, reviewed the statistical analyses, and approved the final manuscript as submitted.
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McManus, B.M., Chi, D. & Carle, A. State Medicaid Eligibility Criteria and Unmet Preventive Dental Care Need for CSHCN. Matern Child Health J 20, 456–465 (2016). https://doi.org/10.1007/s10995-015-1843-6
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DOI: https://doi.org/10.1007/s10995-015-1843-6