Article

Preventive dental utilization for Medicaid‐enrolled children in Iowa identified with intellectual and/or developmental disability

Department of Pediatric Dentistry, The University of Iowa
Journal of Public Health Dentistry (Impact Factor: 1.65). 12/2009; 70(1):35 - 44. DOI: 10.1111/j.1752-7325.2009.00141.x

ABSTRACT

Objectives: To compare preventive dental utilization for children with intellectual and/or developmental disability (IDD) and those without IDD and to identify factors associated with dental utilization.Methods: We analyzed Iowa Medicaid dental claims submitted during calendar year (CY) 2005 for a cohort of children ages 3-17 who were eligible for Medicaid for at least 11 months in CY 2005 (n = 107,605). A protocol for identifying IDD children was developed by a group of dentists and physicians with clinical experience in treating children with disabilities. Utilization rates were compared for the two groups. Crude and covariate-adjusted odds ratios were estimated using conditional logistic regression modeling.Results: A significantly higher proportion of non-IDD children received preventive care than those identified as IDD (48.6 percent versus 46.1 percent; P < 0.001). However, the final model revealed no statistically significant difference between the two groups. Factors such as older age, not residing in a dental Health Professional Shortage Area, interaction with the medical system, and family characteristics increased one's likelihood of receiving preventive dental care.Conclusion: Although IDD children face additional barriers to receiving dental care and may be at greater risk for dental disease, they utilize preventive dental services at the same rate as non-IDD children. Clinical and policy efforts should focus on ensuring that all Medicaid-enrolled children receive need-appropriate levels of preventive dental care.

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Available from: Donald L. Chi, Oct 07, 2014
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    • "This finding has oral health-related implications especially if the child has a poor diet or behavioral comorbidities that make it difficult for caregivers to brush the child’s teeth regularly with fluoridated toothpaste. These findings appear to conflict with previous work suggesting that Medicaid-enrolled children with intellectual or developmental disabilities are equally as likely to use preventive dental care as those without [13]. A possible explanation for this inconsistency is that children with intellectual or developmental disabilities present with varying degrees of disability. "
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    ABSTRACT: Dental care is the most common unmet health care need for children with chronic conditions. However, anecdotal evidence suggests that not all children with chronic conditions encounter difficulties accessing dental care. The goals of this study are to evaluate dental care use for Medicaid-enrolled children with chronic conditions and to identify the subgroups of children with chronic conditions that are the least likely to use dental care services. This study focused on children with chronic conditions ages 3-14 enrolled in the Iowa Medicaid Program in 2005 and 2006. The independent variables were whether a child had each of the following 10 body system-based chronic conditions (no/yes): hematologic; cardiovascular; craniofacial; diabetes; endocrine; digestive; ear/nose/throat; respiratory; catastrophic neurological; or musculoskeletal. The primary outcome measure was use of any dental care in 2006. Secondary outcomes, also measured in 2006, were use of diagnostic dental care, preventive dental care, routine restorative dental care, and complex restorative dental care. We used Poisson regression models to estimate the relative risk (RR) associated with each of the five outcome measures across the 10 chronic conditions. Across the 10 chronic condition subgroups, unadjusted dental utilization rates ranged from 44.3% (children with catastrophic neurological conditions) to 60.2% (children with musculoskeletal conditions). After adjusting for model covariates, children with catastrophic neurological conditions were significantly less likely to use most types of dental care (RR: 0.48 to 0.73). When there were differences, children with endocrine or craniofacial conditions were less likely to use dental care whereas children with hematologic or digestive conditions were more likely to use dental care. Children with respiratory, musculoskeletal, or ear/nose/throat conditions were more likely to use most types of dental care compared to other children with chronic conditions but without these specific conditions (RR: 1.03 to 1.13; 1.0 to 1.08; 1.02 to 1.12; respectively). There was no difference in use across all types of dental care for children with diabetes or cardiovascular conditions compared to other children with chronic conditions who did not have these particular conditions. Dental utilization is not homogeneous across chronic condition subgroups. Nearly 42% of children in our study did not use any dental care in 2006. These findings support the development of multilevel clinical interventions that target subgroups of Medicaid-enrolled children with chronic conditions that are most likely to have problems accessing dental care.
    Full-text · Article · Aug 2012 · BMC Oral Health
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    • "This special group of children, aged 1–17 years, do not receive PDC as much as CSHCS who are not enrolled in Medicaid because of the low reimbursements of Medicaid dental procedures [35]. Another comparative preventive dental utilization study was made in Iowa by Chi and colleagues [36]. Investigators from Iowa compared intellectual and/or development disability (IDD) Medicaid-enrolled children with peers without IDD to study their utilization of PDC. "
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    ABSTRACT: Pediatric dental caries is the most common chronic disease among children. Above 40% of the U.S. children aged 2-11 years have dental caries; more than 50% of them come from low-income families. Under dental services of the Medicaid program, children enrolled in Medicaid must receive preventive dental services. However, only 1/5 of them utilize preventive dental services. The purpose of this overview is to measure the impact of Medicaid dental benefits on reducing oral health disparities among Medicaid-eligible children. This paper explains the importance of preventive dental care, children at high risk of dental caries, Medicaid dental benefits, utilization of dental preventive services by Medicaid-eligible children, dental utilization influencing factors, and outcome evaluation of Medicaid in preventing dental caries among children. In conclusion, despite the recent increase of children enrolled in Medicaid, utilizing preventive dental care is still a real challenge that faces Medicaid.
    Full-text · Article · Mar 2012 · International Journal of Dentistry
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    • "Inadequate access to dental care services is a problem for vulnerable populations in the United States (U.S.), in part because there is a geographic maldistribution of dentists [1-3]. Over 49 million individuals in the U.S. reside in a dental Health Professional Shortage Area (HPSA) [4,5]. "
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