Dataset Information

Provision of fluoride varnish to Medicaid-enrolled children by physicians: the Massachusetts experience.

ABSTRACT:

Objectives

To evaluate the impact of a 2008 Medicaid policy in Massachusetts (MA), regarding reimbursing physicians for providing fluoride varnish (FV) to eligible children in medical settings.

Data source

Survey of a sample of primary care physicians in MA.

Study design

Cross-sectional survey of a sample of physicians who provide care to MassHealth (MA Medicaid) enrolled-children.

Dependent variables

history of completed preventive dental skills training, and FV provision.

Independent variables

oral health knowledge, FV-attitudes, and physician and practice characteristics.

Principal findings

Overall, 19 percent of respondents had completed the training required to be eligible to bill for FV provision. Only 5 percent of physicians were providing FV. Most respondents (63 percent) were not familiar with the new policy, and only 25 percent felt that FV should be provided during well-child visits. Most physicians (60 percent) did not feel that the reimbursement rate of U.S.$26/application was sufficient; 17 percent said that they would not provide FV, regardless of payment. Most common barriers to FV provision were a lack of time and logistical challenges.

Conclusions

Our findings suggest that simply reimbursing physicians for FV provision is insufficient to ensure provider participation. Success of this policy will likely require addressing several barriers identified.

SUBMITTER: Isong IA

PROVIDER: S-EPMC3393025 | biostudies-literature | 2011 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Provision of fluoride varnish to Medicaid-enrolled children by physicians: the Massachusetts experience.

Isong Inyang A IA Silk Hugh H Rao Sowmya R SR Perrin James M JM Savageau Judith A JA Donelan Karen K

Health services research 20110715 6pt1

<h4>Objectives</h4>To evaluate the impact of a 2008 Medicaid policy in Massachusetts (MA), regarding reimbursing physicians for providing fluoride varnish (FV) to eligible children in medical settings.<h4>Data source</h4>Survey of a sample of primary care physicians in MA.<h4>Study design</h4>Cross-sectional survey of a sample of physicians who provide care to MassHealth (MA Medicaid) enrolled-children.<h4>Dependent variables</h4>history of completed preventive dental skills training, and FV pro ...[more]

PMID: 21762142

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Project description:ImportanceBrief disruptions in insurance coverage among eligible participants are associated with poorer health outcomes for children.ObjectiveTo describe factors associated with coverage disruptions among children enrolled in North Carolina Medicaid from 2016 to 2018 and estimate the outcome of preventing such disruptions on medical expenditures.Design setting and participantsThis was a retrospective cohort study using North Carolina Medicaid claims data. All enrolled individuals were aged 1 to 20 years on January 1, 2016, and with 30 days of prior continuous enrollment. Children were observed from January 1, 2016, until December 31, 2018. Analyses were conducted from June 2020 through December 2020.Main outcomes and measuresRisk of Medicaid coverage disruptions of 1 to less than 12 months was assessed. Among children who disenrolled from Medicaid for 30 or more days, the risk of reenrollment within 1 to 6 months and 7 to 11 months was assessed. An inverse probability of censoring weights method was then used to estimate the outcome of an intervention to reduce coverage disruptions through preventing disenrollment on per member per month (PMPM) cost.ResultsThe study population included 831 173 Medicaid beneficiaries aged 1 to 5 years (23%), 6 to 17 years (68%), and 18 to 20 years (9%); 35% were Black, 44% were White, and 14% were Hispanic/Latinx. Among those with a first disenrollment (n = 214 401, 26%), the risk of reenrollment within 6 months and 7 to 11 months was 19% and 7%, respectively. Risk of coverage disruption was higher for Black children (hazard ratio [HR], 1.21; 95% CI, 1.18-1.24), children of other races (Asian, American Indian, Hawaiian or Pacific Islander, multiple races, or unreported; HR, 1.37; 95% CI, 1.33-1.40), and Latinx children (HR, 1.65; 95% CI, 1.60-1.70) compared with White children. Risk of coverage disruption was also higher for children with higher medical complexity (HR, 1.15; 95% CI, 1.12-1.19). The risk of coverage disruption was lower for children living in counties with the highest unemployment rates (HR, 0.89; 95% CI, 0.85-0.94), and comparisons between county-level measures of child poverty and graduation rates showed little or no difference. The estimated PMPM cost for the full population under a scenario in which all medical costs were included was $125.73. Estimated PMPM cost for the full cohort in a counterfactual scenario in which disenrollment was prevented was slightly lower ($122.14). Across all subgroups, estimated PMPM costs were modestly lower ($2-$8) in the scenario in which disenrollment was prevented.Conclusions and relevanceIn this cohort study, the risk of Medicaid coverage disruption was high, with many eligible children in historically marginalized communities continuing to experience unstable enrollment. In addition to improving health outcomes, preventing coverage gaps through policies that decrease disenrollment may also reduce Medicaid costs.

Dataset Information

Provision of fluoride varnish to Medicaid-enrolled children by physicians: the Massachusetts experience.

Objectives

Data source

Study design

Dependent variables

Independent variables

Principal findings

Conclusions

Publications

Provision of fluoride varnish to Medicaid-enrolled children by physicians: the Massachusetts experience.

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