Compliance and Efficacy of Orthodontic Medicaid in Southern Nevada: A Retrospective Study

Objective: The study’s main objective is to evaluate efficacy and compliance in Medicaid orthodontic patients compared to private insurance and cash (self-pay) patients in Southern Nevada. In addition, the paper will study the trends in approval selection such gender, age, race/ethnicity, and case type. This information will be used to discuss the barriers that Medicaid patients face and offer solutions for the issues found in the orthodontic Medicaid system. Introduction: Medicaid coverage was brought forward by the Federal Social Security Act in July of 1965. Since then, there have been many discussions on how orthodontic treatment should be covered under the Medicaid umbrella. With the states having the ability to determine allocation of resources, reimbursement, and qualifications, there tends to be great confusion around the system from state to state. Medicaid patients and providers also face many other barriers to treatment, including the preconceived notions of treatment inefficiency and lack of patient compliance. There have been studies done in states such as North Carolina, Iowa, Illinois, Washington, and Texas to analyze the state orthodontic Medicaid, but no similar studies have been conducted in Nevada. With 938,519 Medicaid enrollees in Nevada, or 1 in 4 people, it is important to understand this population to help educate both providers and patients in order to better the system as a whole. Methods: A retrospective study was completed by analyzing data from the electronic health record (EHR) system [axiUm] from UNLV School of Dental Medicine over a 3-year period from 3/1/2016-3/1/2019. The information collected was used to compare efficacy and compliance of orthodontic Medicaid vs orthodontic non-Medicaid patients based on grading criteria of treatment time, broken appointments, emergency appointments, and compliance. Results: Overall, there were 342 patients in the study consisting of 122 Medicaid and 220 non- Medicaid patients. Medicaid patients averaged longer treatment time, 31.5 months vs 28.5 months, and more appointments, 27.4 vs 24.2. However, this was expected as it was found that the Medicaid approval process leads to more complex cases as a group. In terms of grading criteria, there was no statistical significance found to make definite conclusions in any of the four criteria of compliance and efficacy. Medicaid patients finished over treatment time more often, 53% vs 46%, and had a higher percentage of recurrent compliance notes, 53% to 46%, than non- Medicaid patients. Inversely, Medicaid patients had a smaller percentage of patients with a “high risk” broken appointment rate, 27% vs 35%, and a smaller percentage of patients that had more than 1 emergency appointment, 30% vs 36%, than the non-Medicaid group. Discussion and Conclusions: The study did not find any statistically significant evidence to say that Medicaid patients differ from non-Medicaid patients in compliance or efficacy in Southern Nevada. The Medicaid patient faces great barriers in the access to orthodontic care, but many preconceptions of the patient are misguided. The onus of the extremely low utilization rate falls on the system, and there is still great importance in the effort to help serve this large and growing population more effectively.