Reimbursement rates and policies for primary molar pit-and-fissure sealants across state Medicaid programs

Donald L Chi; Jennifer Singh

doi:10.14219/jada.archive.2013.0056

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Reimbursement rates and policies for primary molar pit-and-fissure sealants across state Medicaid programs

Journal article

Open access

Peer reviewed

Reimbursement rates and policies for primary molar pit-and-fissure sealants across state Medicaid programs

Donald L Chi and Jennifer Singh

The Journal of the American Dental Association (1939), Vol.144(11), pp.1272-1278

11/2013

DOI: 10.14219/jada.archive.2013.0056

PMID: 24177406

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Abstract

Background Little is known about Medicaid policies regarding reimbursement for placement of sealants on primary molars. The authors identified Medicaid programs that reimbursed dentists for placing primary molar sealants and hypothesized that these programs had higher reimbursement rates than did state programs that did not reimburse for primary molar sealants. Methods The authors obtained Medicaid reimbursement data from online fee schedules and determined whether each state Medicaid program reimbursed for primary molar sealants (no or yes). The outcome measure was the reimbursement rate for permanent tooth sealants (calculated in 2012 U.S. dollars). The authors compared mean reimbursement rates by using the t test (α = .05). Results Seventeen Medicaid programs reimbursed dentists for placing primary molar sealants (34 percent), and the mean reimbursement rate was $27.57 (range, $16.00 [Maine] to $49.68 [Alaska]). All 50 programs reimbursed dentists for placement of sealants on permanent teeth. The mean reimbursement for permanent tooth sealants was significantly higher in programs that reimbursed for primary molar sealants than in programs that did not ($28.51 and $23.67, respectively; P = .03). Conclusions Most state Medicaid programs do not reimburse dentists for placing sealants on primary molars, but programs that do so have significantly higher reimbursement rates. Practical Implications Medicaid reimbursement rates are related to dentists' participation in Medicaid and children's dental care use. Reimbursement for placement of sealants on primary molars is a proxy for Medicaid program generosity.

United States

Child

Humans

Insurance, Health, Reimbursement - statistics & numerical data

Medicaid - organization & administration

Medicaid - standards

Molar

Organizational Policy

Pit and Fissure Sealants - economics

Pit and Fissure Sealants - therapeutic use

State Government

Tooth, Deciduous

Details

Title: Subtitle: Reimbursement rates and policies for primary molar pit-and-fissure sealants across state Medicaid programs
Creators: Donald L Chi - University of Washington
Jennifer Singh - University of Washington
Resource Type: Journal article
Publication Details: The Journal of the American Dental Association (1939), Vol.144(11), pp.1272-1278
DOI: 10.14219/jada.archive.2013.0056
PMID: 24177406
NLM abbreviation: J Am Dent Assoc
ISSN: 0002-8177
eISSN: 1943-4723
Publisher: American Dental Association
Grant note: L60MD003921 / NIMHD NIH HHS K08DE020856 / NIDCR NIH HHS
Language: English
Date published: 11/2013
Academic Unit: Public Policy Center (Archive)
Record Identifier: 9984283709002771

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