273 - Medicaid Coverage for Preventative vs Restorative vs Space Maintenance Services in Pediatric Dentistry in Pennsylvania

Objective: Pediatric dental caries is the most common chronic disease among youth, affecting 46% of children ages two-19 years old. Children, therefore, deserve access to the prevention and treatment of dental caries as well as access to space maintainers which are necessary in maintaining proper oral health by preventing complications like crowding and misalignment in those affected by the dental caries disease process. Many of these children are of low socioeconomic status (SES) and are enrolled in Medicaid. Medicaid provides free or low-cost medical benefits to adults and children with limited income and resources. The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid and at a minimum, dental services include relief of pain and infections, restoration of teeth, and maintenance of dental health. The aim of the study is to analyze financial compensation for various types of pediatric dental services including preventative, restorative, and space maintenance using government insurance in different states of the United States of America.

Data Sources: We reviewed Medicaid dental fee schedules of all 50 states to compare preventative vs restorative coverage using CDT codes. Preventative services include sealants, comprehensive exam, prophy, fluoride varnish, BW, panoramic, unilateral SPM, bilateral SPM, distal shoe vs restorative services which include SSC, resin crown, 1 surface resin, 2 surface resin, pulpotomy, pulpectomy, zirconia crown.

Results: By using descriptive statistics, there is quite a bit of range and distribution difference in these states with regards to each of our categories and overall reimbursement rates. However, using statistical analysis to determine variance and significance, the only statistical differences noted via p values are when comparing preventative procedures between Pennsylvania and New Jersey (p= 0.003), and all of the comparisons from Pennsylvania to Delaware (restorative p=0.001; preventative p=0.03; space maintenance p=0.001) . Greater statistical analysis could be performed since the data is not necessarily normal or comprehensive (in that some states cover procedures that others don't). However, as costs of procedures do not vary to the level that pricing does, there can still be impact on the access to care and reimbursement rates that are not captured in statistical analyses.

Conclusions: This pilot project comparing reimbursement for specific procedures shows the vast range for how reimbursement varies amongst states, even in the same region. It can be the basis for future projects gauging more specifics with regards to reimbursement. More analysis on how state budgets and regionality affects priorities with reimbursement would be helpful.