medicaid and orthodontics
Effects of New York State’s Medicaid Orthodontic Policy Changes on Approved Orthodontic Treatment Complexity June Harewood, D.D.S., M.A., M.S.; Karolina Kister, D.M.D., Ph,D.; Lynn Tepper, Ph.D., Ed.D.; Hassan M. Khan, D.M.D., M.B.E., M.S.; Jing Chen, D.D.S., Ph.D.; Christine O’Hea, D.M.D., M.Sc.; Thomas Hoopes; Sunil Wadhwa, D.D.S., Ph.D.
ABSTRACT The purpose of this study was to analyze how 2013 New York State Medicaid legislation that introduced the Handicapping Labio-lingual Deviation (HLD) Index affected orthodontic Medicaid treatment approval. Eighty-six patients pre-2013 and 86 post-2013 were selected from a single academic center. The number of patients who auto-qualified post-2013 significantly increased (58 vs 39, p=0.006). For the patients who did not auto-qualify, there was a significant increase (p=0.017) in HLD scores post-2013 (31.38) compared to pre-2013 (13.34). Fifty-one percent of the patients approved pre-2013 would not have qualified for coverage under the current policy. Before 2013, New York State used a subjective method for the selection and approval of orthodontic Medicaid services for people who resided in the state of New York. Eligible individuals were referred to one of three screening academic institutions (Columbia, NYU and Montefiore), where they would be seen by a faculty orthodontist to determine the need for orthodontic treatment. The
28
APRIL 2022
●
The New York State Dental Journal
orthodontist would subjectively evaluate the occlusion and either recommend or not recommend orthodontic treatment. The recommendations would be sent to the New York State Orthodontic Rehabilitation Program, which would issue an authorization. In 2013, New York State legislation reformed the orthodontic treatment approval process from subjective orthodontist approval to a standardized Handicapping Labio-lingual Deviation (HLD) Index.[1] State-sponsored insurance will now cover comprehensive orthodontic treatment if patients possess one of six autoqualifying conditions, or if they meet a minimum HLD score of 26 under the quantitative criteria of the index (Tables 1, 2). The assumption here is that orthodontics is medically necessary only for individuals who possess one of the six auto-qualifying conditions, or who have an HLD score above 26. The challenge in proving orthodontic treatment that is medically necessary occurs because malocclusion has varying degrees of severity. Some individuals who seek orthodontic treatment may do so for purely esthetic reasons. However, although controversial, there is a subset of the population for whom orthodontic correction may have a significant effect on the function and health of the oral cavity.[2] It is clear that an excess in overjet, defined as greater than 3 mm in the primary dentition and greater than 5 mm in permanent dentition, has been associated with an increase in traumatic dental injuries[3] and that orthodontic
