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Published on: December 31, 2017
Pediatric oral health services in Medicaid managed care and fee for service
Annie Yu-An Chen1, Isaac M Opper, Andrew W Dick
1RAND Corporation, 20 Park Plaza, 9th Floor, Ste 920, Boston, MA 02116.
Insights
Preventive oral health services (POHS) in Florida Medicaid showed similar rates between comprehensive managed care (CMC) and fee-for-service (FFS) plans for young children. Rates were low but increased over time, a key finding as more children enroll in CMC.
Area of Science:
- Public Health
- Health Services Research
- Pediatric Medicine
Background:
- Florida Medicaid introduced reimbursement for preventive oral health services (POHS) for young children in 2008.
- Understanding disparities in POHS delivery between different Medicaid payment models is crucial for child health equity.
Purpose of the Study:
- To compare the rates of preventive oral health services (POHS) delivered during pediatric medical visits under Florida's Medicaid comprehensive managed care (CMC) and fee-for-service (FFS) plans.
- To assess the impact of a policy allowing POHS in medical settings on utilization rates over time.
Main Methods:
- An observational study analyzed Florida Medicaid claims data from 2009-2012 for children aged 3.5 years or younger.
- A weighted logistic regression model compared POHS rates between CMC and FFS, controlling for policy implementation and demographic factors.
Main Results:
- Preventive oral health services (POHS) were utilized in 8.33% of CMC visits and 9.67% of FFS visits.
- While CMC visits showed a nonsignificant trend towards lower POHS rates (-1.29 percentage points), rates increased modestly over time for both models.
- A significant difference was observed after 3 years, with CMC having lower rates, suggesting potential implementation lags.
Conclusions:
- Preventive oral health services (POHS) utilization rates were comparable between Florida's Medicaid CMC and FFS plans for young children.
- Low but increasing POHS rates highlight the need for continued monitoring and potential interventions, especially with rising CMC enrollment.
- The findings underscore the importance of ensuring equitable access to preventive care across different Medicaid delivery systems.
Objectives:
In 2008, Florida's Medicaid program began reimbursing medical providers for preventive oral health services (POHS) delivered to children aged 6 months to 42 months. We examine whether Medicaid comprehensive managed care (CMC) and fee for service (FFS) had different rates of POHS during pediatric medical visits.
Study Design:
Observational study using claims data (2009-2012).
Methods:
Using repeated cross-sections of 2009-2012 Florida Medicaid data for children 3.5 years or younger, we examined pediatric medical visits. We estimated a weighted logistic regression model to compare POHS rates among visits reimbursed by CMC and FFS Medicaid. The model controlled for FFS (vs CMC), years Florida had a policy allowing POHS in medical settings, an interaction between these 2 variables, and additional child- and county-level characteristics. Results are presented as regression-adjusted predictions.
Results:
Among 1,765,365 weighted well-child medical visits in Florida, POHS were included in 8.33% of CMC-reimbursed visits and 9.67% of FFS-reimbursed visits. Compared with FFS, CMC-reimbursed visits had a nonsignificant 1.29-percentage-point lower adjusted probability of including POHS (P = .25). When examining differences over time, although the POHS rate was 2.72 percentage points lower for CMC-reimbursed visits after 3 years of policy enactment (P = .03), rates were similar overall and increased over time.
Conclusions:
POHS rates among pediatric medical visits in Florida were similar for visits paid via FFS and CMC, with low rates that increased modestly over time. Our findings are important because more children continue to be enrolled in Medicaid CMC.
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