Insurance Coverage Policies and Outcomes of Children with Oral Clefts

University Of Iowa, Iowa City IA

Investigators

Linked publications & trials

Abstract

? DESCRIPTION (provided by applicant): Cleft lip and/or cleft palate (oral clefts) are common birth defects affecting about 1 in 1250 children in the US. Numerous health interventions including surgical, medical, dental, speech services are needed to target the multiple health complications related to clefts including feeding, dental, speech, and psychosocial problems. For a variety of reasons, children with clefts often do not receive all services needed to develop a normal physical appearance and functional ability. A key barrier to accessing needed services is that the services are not always covered by insurance. Many states have attempted to address barriers to care through laws mandating coverage of certain services by private insurance plans and through modifying requirements for coverage of services in their Medicaid programs. While it is clear that significant policy variation exists between states, what effect th policies have on health services use and access to care for children with oral clefts is unknown. The proposed study will assess how the generosity of state laws mandating coverage of services needed to treat oral clefts and their complications in private insurance plans and Medicaid programs matters in utilization of care. The study will examine the effects of specific policies that are highly relevant to the healthcare needs of children with oral clefts on use of specific services that are likely to be impacted by these policies capturing both timeliness and frequency of use. For private insurance, we measure the state's comprehensiveness in mandating a range of services needed by children with clefts as well as mandates for surgical treatments and speech therapy. For Medicaid, we focus on the state's medically necessary standards and generosity of covering orthodontic treatment for children with oral clefts. The analysis will employ large population-based datasets of children with oral clefts in private coverage and Medicaid. The findings will be highly relevant for understanding barriers to care in this population and can be directly translated into policymaking to improve access to needed services in this population. Devising effective policies is the primary and most efficient mechanism for addressing barriers to care on a population level. This study will identify the extent to which enacted policies matter for access to key health services for children with oral clefts.