(SDAS) The impact of a policy change in Wisconsin authorizing non-dental provders to bill Medicaid for the application of fluoride varnish to children's teeth

Project Number: R40 MC 08955-01
Project Date: 2/1/2008
Grantee: Marquette University
Department/Center: Clinical Service/Public Health/School of Dentistry

Final Report

Pending

Principal Investigator

Christopher Okunseri DDPH,
Assistant Professor, Marquette University Clinical Service/Public Health/School of Dentistry,
Post Office Box 1881
Milwaukee, Wisconsin 53201-1881
christopher.okunseri@marquette.edu

Abstract

Approximately 2.5 million children between the ages of two and five years in the United States suffer from dental caries, a chronic and infectious disease that is preventable with early preventive measures, sustainable home care, and appropriate periodic dental visits. Medicaid, a jointly funded federal and state program, requires that eligible children who are enrolled receive preventive dental services through the Early and Periodic Screening, Diagnostic and Treatment program. However, only one child in every five enrolled in Medicaid receives dental services. In 2004, policymakers amended the Wisconsin Medicaid program’s preventive dental procedure guidelines to address a gap in service provision. Wisconsin, along with eight other States, now allows non-dental providers to apply, and bill Medicaid for, fluoride varnish applications to children’s teeth aged one to five years, who live in poverty, are minorities and/or who have special health care needs. It remains unclear, however, whether this change in policy has resulted in an appreciable increase in fluoride varnish applications for children enrolled in Medicaid. This study will examine whether there is an increase in the application of fluoride varnish to the teeth of children who are enrolled in Medicaid following the change in policy. Also, the study will examine how three main domains (patient, provider and county level characteristics) have impacted the rate of fluoride varnish application and utilization among Medicaid enrollees. The study will use data from the Electronic Data Systems of Medicaid Evaluation and Decision Support (MEDS) for Wisconsin for 2002-2006. This database is managed by the Division of Health Care Financing in the Wisconsin Department of Health and Family Services and contains all Medicaid claims for the state of Wisconsin. Descriptive statistics and multivariate regression models will be used to estimate the effect of the policy change on the rate at which Medicaid eligible children receive fluoride varnish and the rate at which they seek this application from non-dental providers. We will control for other covariates including child’s county of residence, age and year effects. This project addresses all four of the Strategic Research Issues established by the Maternal and Child Health Bureau (MCHB). First, it will determine whether there is an increase in the rate of fluoride varnish application and utilization by children. Second, if there has been an increase, to explore whether it can be attributed to the involvement of non-dental providers by examining the settings and types of non-dental providers most likely to provide fluoride varnish to children. Third, it will explore patients’ socio-demographics, and provider and county level characteristics that might account for the observed differences. Fourth, it will estimate the effect of race/ethnicity on the receipt of fluoride varnish from a non-dental provider. This secondary data analysis project will improve our knowledge on the benefits of allowing non-dental providers to provide fluoride varnish. This research is important for future potential expansion of the policy into other states to enhance the overall improvement of oral health in children.

Publications

Pending

Keywords

Public policy, Provider participation, Preventive health care, Minority groups, Medicaid, Infants, EPSDT, Clinics