State Medicaid Eligibility Criteria and Unmet Preventive Dental Care Need for CSHCN
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State Medicaid Eligibility Criteria and Unmet Preventive Dental Care Need for CSHCN Beth M. McManus1 • Donald Chi2 • Adam Carle3
Published online: 31 October 2015 Ó Springer Science+Business Media New York 2015
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 statelevel 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
& Beth M. McManus [email protected] 1
Department of Health Systems, Management and Policy, Colorado School of Public Health and Children’s Outcomes Research Group, Children’s Hospital Colorado, 13001 E. 17th Place, MS B117, Aurora, CO 80045, USA
2
Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
3
Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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policy implications for improving oral health disparities for publicly-insured CSHCN. Keywords Medicaid Dental care National Survey of Children with Special Health Care Needs Multi-level models Abbreviations ACA Patient Protection and Affordable Care Act MLM Multilevel model NS-CSHCN National Survey of Children with Special Health Care Needs
Significance Medicaid-enrolled children with special health care needs often experience barriers to routine dental care. Among a nationally representative sample of Medicaid-eligible CSHCN, state Medicaid reimbursement rates are inversely associated with parent-reported unmet need for preventive dental care. The results of this study suggest that there is significant state variability in unmet need for preventive dental care for Medicaid-enrolled CSHCN. Yet, broadening Medicaid eligibility criteria alone is not likely to address the preventive dental care needs of CSHCN.
Introduction The American Academy of Pediatrics recommends dental visits every 6 months to provide direct preventive dental care, through sealants and topical fluoride, and anticipatory
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