Longitudinal Examination of Changes in Medicaid Adult Dental Coverage and Spillover Effects on Children

项目摘要 尽管美国在改善儿童牙科保健方面取得了重大进展， 近几十年来，在公共保险的儿童中，口腔健康方面的巨大差距一直存在。虽然 医疗补助计划为所有登记的儿童提供全面的牙科保险，成人的牙科福利是 可选，并随时间和州而变化。有证据表明，减少医疗补助成人牙科福利 （MADB）降低了低收入成年人获得牙科护理的机会。然而，MADB的变化对 目前还不了解参加医疗补助计划的儿童获得牙科保健的情况。 我们的长期目标是改善低收入儿童获得牙科保健和口腔健康的结果。 家庭为了实现这一目标，我们将利用各州的自然实验，改变MADB的慷慨程度， 检查医疗补助登记儿童对牙科使用的溢出效应。我们假设扩张 MADB的慷慨导致预防性和整体牙科使用率的增加， 参加医疗补助计划的儿童因牙齿问题到急诊室就诊。使用因果推理 方法，我们将估计MADB的变化对儿童牙科保健利用的纵向影响 通过这些研究目标： 目标1：确定MADB慷慨度变化对儿童整体牙科使用的影响 参加医疗补助使用行政数据与准实验设计。 目的2：确定MADB慷慨度变化对儿童预防性牙科使用的影响 参加医疗补助使用行政数据与准实验设计。 目标3：确定MADB慷慨度变化对急诊科（艾德）牙科的影响 使用准实验设计的管理数据，在医疗补助注册的儿童利用。 使用管理数据，我们将生成这三种利用率度量的月度估计值，并使用 评估MADB前后儿童牙科使用趋势变化的因果推理框架 政策变化。我们将使用中断的时间序列方法来解释任何长期趋势，并使其稳健 州内比较，并补充以差异方法中的差异来提供比较 与没有经历政策变化的对照国进行比较。 我们的研究结果将提供证据证明MADB的慷慨对儿童获得牙科治疗的溢出效应 在乎本研究将首次使用行政数据来检验改变MADB的溢出效应 对儿童牙科保健的慷慨使用。该研究与NIDCR的战略优先事项保持一致， 并努力减少儿童口腔健康差异。

Project Summary Despite significant overall progress in improving access to dental care among children in the United States in recent decades, substantial disparities in oral health have persisted among publicly insured children. Although Medicaid provides comprehensive dental coverage for all enrolled children, dental benefits for adults are optional and vary across states and over time. There is evidence that reducing Medicaid adult dental benefits (MADB) lowers access to dental care for low-income adults. However, the impact of changes in MADB on access to dental care for Medicaid-enrolled children is not yet understood. Our long-term goal is to improve access to dental care and oral health outcomes among children in low-income families. To achieve this goal, we will leverage natural experiments in states that changed MADB generosity to examine the spillover effect on dental utilization by Medicaid-enrolled children. We hypothesize that expanding MADB generosity results in increases in both preventive and overall dental utilization and a decline in emergency department visits for dental problems by Medicaid-enrolled children. Using a causal inference approach, we will estimate the longitudinal impact of changes in MADB on children’s dental care utilization through these research aims: Aim 1: Determine the impact of changes in MADB generosity on overall dental utilization by children enrolled in Medicaid using administrative data with a quasi-experimental design. Aim 2: Determine the impact of changes in MADB generosity on preventive dental utilization by children enrolled in Medicaid using administrative data with a quasi-experimental design. Aim 3: Determine the impact of changes in MADB generosity on emergency department (ED) dental utilization by children enrolled in Medicaid using administrative data with a quasi-experimental design. Using administrative data, we will generate monthly estimates of these three measures of utilization and use a causal inference framework to assess the changes in child dental utilization trends before and after the MADB policy changes. We will use interrupted time series approach to account for any secular trends and make robust within state comparisons, and supplement it with a differences in difference approach to provide comparison with control states that did not experience a policy change. Our findings will provide evidence on the spillover effect of MADB generosity on children’s access to dental care. This study will be the first to use administrative data to examine the spillover effect of changing MADB generosity on children’s dental care use. The study aligns with the strategic priorities of NIDCR to understand and work to reduce child oral health disparities.