Impact of Medicaid Expansion on State-Level Medicaid Reimbursement for Orthodontia in Patients With Cleft Lip and Palate: A Cost Analysis.
Objective : Examine state-level Medicaid reimbursement rates after Medicaid expansion for Phase I and II orthodontia relevant to patients with cleft lip and palate. Design : Cross-sectional study of publicly available 2024 state Medicaid reimbursement rates associated with Phase I and II orthodontia...
| Publicado en: | Cleft Palate Craniofacial Journal Vol. 63; no. 3; pp. 422 - 429 |
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| Autores principales: | , , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
Sage Publications Inc.
Mar2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=192008502&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 192008502 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10556656 DF1 jtl: Cleft Palate Craniofacial Journal issn: 10556656 maglogo: Y pubinfo: dt: Mar2026 vid: 63 iid: 3 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 192008502 191565540 192008502 192008502 10.1177/10556656261421052 192008502 ppf: 422 ppct: 7 formats: tig: atl: Impact of Medicaid Expansion on State-Level Medicaid Reimbursement for Orthodontia in Patients With Cleft Lip and Palate: A Cost Analysis. aug: au: McCall, Ronald Rae Elver, Ashlie A Pitre, Kendall C Hoppe, Ian C Humphries, Laura S affil: School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA sug: subj: Cleft Lip Surgery Cleft Palate Surgery Orthognathic Surgery Medicaid Expansion United States Orthodontics Economics Insurance, Health, Reimbursement Evaluation Health Care Costs Human Cross Sectional Studies Fee for Service Plans United States One-Way Analysis of Variance T-Tests Health Services Accessibility Income Treatment Delay Risk Factors Risk Assessment Poverty Cost of Living Pediatric Care Socioeconomic Factors Interinstitutional Relations Health Policy Descriptive Statistics Data Analysis Software ab: Objective : Examine state-level Medicaid reimbursement rates after Medicaid expansion for Phase I and II orthodontia relevant to patients with cleft lip and palate. Design : Cross-sectional study of publicly available 2024 state Medicaid reimbursement rates associated with Phase I and II orthodontia. One-Way ANOVA and independent t-tests compared regional and Medicaid expansion groups. Setting : National sample of Medicaid reimbursement fee schedules. Patients : Fifty US states, including DC, utilizing fee-for-service reimbursement for Medicaid enrollees. Main Outcome Measure(s) : Reimbursement Rates for CPT Code D8020 (Phase I: Limited Orthodontia, Transitional Dentition) and D8080 (Phase II: Comprehensive Orthodontia, Adolescent Dentition) were compared between regions and by Medicaid expansion status. Results : Ten states did not adopt Medicaid Expansion (19.6%: AL, FL, GA, KS, MS, SC, TN, TX, WI, and WY). Coverage of Phase I care was low overall (58.5% of expanded and 55.6% of non-expanded states), with average reimbursement of $1080.13. More states offered Phase II coverage (87.8% of expanded and 77.8% of non-expanded states). Phase II reimbursement was higher in expansion states ($2596.73 ± $2252.59 vs non-expansion: $1266.78 ± $314.19; P =.001). The South trended toward higher reimbursement for Phase II ($3224.95; P =.093), followed by the West ($2902.88 ± 1327.40 vs $1413.26-$1699.10). Conclusions : Provider reimbursement influences access to orthodontia. Although Medicaid expansion aims to improve access for low-income families, gaps in orthodontic coverage persist. Despite higher Phase II reimbursement in Southern and expansion states, inadequate Phase I coverage and low reimbursement schedules limit provider participation, leaving low-income patients with clefts at risk for delayed or absent orthodontia and thus suboptimal outcomes. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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