Effective September 1, 2008, Texas Medicaid reimbursed M-PCPs for ECCPS for children ages 6-35 months.
Periodicity schedules for children <3 years old for both well-child and ECCPS visits are defined in months rather than years (i.e., clinical guidelines recommend multiple visits per year).
To identify the treatment effect of M-PCP reimbursement on ECCPS visits, we used difference-in-differences (DD) estimation, which controls for bias stemming from intrinsic differences between the treatment and control groups as well as intervening time factors between the pre- and post-intervention periods.
Because it is uncommon for children to have more than one ECCPS visit per month, we specified our outcome variable as a binary indicator of zero versus one or more visits and used modified Poisson regression combined with generalized estimating equations (GEE).
Figure 1 summarizes per member month (PMM) receipt of ECCPS over time for the full treatment, restricted treatment and control groups for ECCPS-Broad and ECCPS-Fluoride.
In each state, there was a higher percentage of enrollment months with ECCPS receipt in the postpolicy period for both the treatment and control groups and within all subgroups.
A value greater than one indicates the treatment group is more likely to have an ECCPS visit compared to the control group, and a value less than one indicates the treatment group is less likely to have an ECCPS visit compared to the control group.
Because we observed relatively flat ECCPS rates for dental providers in Florida, we estimated models that regressed ECCPS from dental providers on policy to evaluate whether there was a substitution effect: that is, whether M-PCP ECCPS provision was associated with decreased provision by dentists.
We found statistically significant treatment effects of M-PCP reimbursement on ECCPS receipt after controlling for intrinsic differences between the treatment and control groups, time trends, demographic and health characteristics, and enrollment duration.
Despite the observed gains, ECCPS receipt still falls short of recommended care.