Dental homes and preventive dental care use for Medicaid-enrolled children with autism spectrum disorders: Iowa's I-Smile Program

Objective. Medicaid-enrolled children with autism spectrum disorders (ASD) encounter barriers to dental care. Iowa’s I-Smile Program was implemented to improve dental care use for children in Medicaid. While public health programs like I-Smile are also intended to reach vulnerable population subgroups within Medicaid, it is unclear whether programs operate as intended. Our objectives were to test this hypothesis by comparing dental home and preventive dental utilization rates for Medicaid-enrolled children by ASD status and determining I-Smile’s longitudinal influence on ASD-related disparities in dental home and preventive dental utilization.

Methods. We analyzed data for newly Medicaid-enrolled children ages 3-17 years (N=30,059), identified ASD status, and assessed whether the child had a dental home (two dental checkups) or utilized preventive dental care. Log-linear regression models were used to generate rate ratios (RR).

Results. From 2003-2011, 9.8% of children with ASD had dental homes compared to 8% children without ASD;36.3% of children with ASD utilized preventive care compared to 45.7% of children without ASD. There were no significant differences in dental home rates by ASD status during I-Smile pre-implementation, initial implementation, or maturation. There were no significant differences in preventive dental utilization by ASD status during pre-implementation or initial implementation, but children with ASD were significantly less likely to utilize preventive care during maturation (RR:0.79;P<.001). Longitudinal trends in dental home and preventive dental utilization rates were not significant (P=.54 and P=.71, respectively).

Conclusions. To reach vulnerable population subgroups within Medicaid like children with ASD, public health programs like I-Smile should incorporate tailored approaches.