Examining Associations Between Medicaid Policy and Silver Diamine Fluoride Utilization

OBJECTIVE: This retrospective cohort study determined associations between Medicaid reimbursement policies for silver diamine fluoride treatment (SDF) and utilization. METHODS: Data included publicly available Medicaid provider manuals and fee schedules as well as aggregated claims from CareQuest Institute for Oral Health. The main outcome was SDF utilization rate calculated as a percentage of claims per enrollees. Summary statistics and linear mixed models with random intercepts were applied. RESULTS: Fourteen states were included in the analysis. The median SDF utilization rate across states increased from 1.80% (IQR: 1.37%, 2.59%) in 2018 to 3.35% (IQR: 1.94%, 5.54%) in 2022. Of seven potential policy dimensions, only reimbursement amount was significantly associated with SDF utilization rate, and only when accounting for time (β = 0.15; 95% CI: 0.12, 0.18). CONCLUSION: Policy factors, particularly reimbursement amount, likely play a role in SDF utilization; however, additional research is needed to understand how dentists adopt SDF in ways that translate into improved outcomes.