Does increased Medicaid reimbursement result in increased access by nsr11162


									 Does increased Medicaid reimbursement result in increased access to care?

Dr. Bollen received her degree in Orthodontics and a PhD in Oral Biology from the
University of Michigan. She is currently a Professor and Graduate Program Director of the
Department of Orthodontics at the University of Washington in Seattle. She is a Diplomate
of the American Board of Orthodontics and maintains a private practice in the greater
Seattle area.

Orthodontic care becomes increasingly more unaffordable for individuals in the lowest
socio-economical groups. States provide orthodontic coverage through their Medicaid
program for children with severe handicapping malocclusions. However this does not
guarantee access to care since acceptance of Medicaid patients depends on the participation
of orthodontists. Many orthodontists refuse to accept and treat these patients for a variety
of reasons. Reasons for not accepting patients on Medicaid are multiple, but the low
reimbursement rates seem to be the greatest obstacle. Increasing reimbursement rates for
other dental services have resulted in greater access to care. It is not known if the same is
true for orthodontics. The purpose of this proposal is to evaluate if increased Medicaid
reimbursement rates increases access to orthodontic services for the underserved.

Specific aims:
Do higher reimbursement fees of a publicly funded program (Medicaid) result in:
       -Greater numbers of treated patients?
       -Greater numbers of participating orthodontists across the state?
       -Better geographical distribution of participating orthodontists?

The specific aims will be addressed by comparing various states across the nation and by
evaluating the changes in Washington State during the past 3 years. The Medicaid
reimbursement rates are quite different between states. Comparison of provider
participation amongst states will be related to each state’s reimbursement level.
Washington State provides a unique opportunity since it more than doubled its re-
imbursement fees during the summer of 2007. The effects on orthodontist participation
and access to care in response to this change have not yet been evaluated.

If increased reimbursement results in increased access to orthodontic services, states need
to address this issue to improve access to orthodontic treatment for the underserved. The
findings related to Medicaid coverage may also apply to other publicly or privately
supported dental programs and hence may provide information applicable to other dental

Access to orthodontic care is an issue that needs to be addressed early on. Exposing
orthodontic residents to this topic will increase their awareness and may ultimate result in
their efforts to increase access to orthodontic care. The ongoing funded research project at
the University of Washington will expose the residents at this institution to these issues and
may eventually result in increased access to care.
To improve the access to orthodontic care, the AAOF put forth a call for proposals last
year. This research project was developed in response to this call. Without the obtained
AAOF funding, development and execution of this proposal would not have been possible.

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