Variation in the Medicaid eligibility for orthodontic coverage across the States

Dissertation (DScD) --Boston University, Henry M. Goldman School of Dental Medicine, 2013 (Department of Dental Public Health).Includes bibliographic references: leaves 102-110.It is left to each state to specify its own criteria of what defines a handicapping malocclusion and accordingly determine its own eligibility criteria for orthodontic converge under Medicaid. OBJECTIVES: This study aims to examine variation in eligibility criteria for Medicaid orthodontic coverage across the states. Since some states use photographs only and others use both photographs and casts to make treatment coverage decisions, this study aims also to investigate whether using photographs only is valid to assess orthodontic treatment need by comparing occlusal indices scoring on plaster models and photographs. The occlusal indices used are Handicapping Labia-Lingual Deviation (HLD), Salzmann, Treatment Priority Index (TPI),. Peer Assessment Rating (PAR), Index of Treatment Need (IOTN), and Discrepancy Index (DI). A simulated population was utilized to explore variations in eligibility determination for Medicaid orthodontic services as a result of utilizing different indices / criteria across the states using Generalized Estimated Equations (GEE) models. METHODS: Collection of orthodontic eligibility criteria used by each state's Medicaid dental program by searching the state Medicaid website or e-mailing the dental director. The study data collection form was designed to include all states' measures/ criteria ..