{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T01:06:00Z","timestamp":1792631160343,"version":"4.5.0"},"reference-count":57,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T00:00:00Z","timestamp":1726704000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the barriers to obtaining care for patients with orofacial clefts through a survey of Florida-based orthodontists and families and an analysis of the Pediatric Health Information System (PHIS) database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional study utilizing multiple-choice questionnaires completed by Florida orthodontists and caregivers of patients who attended a Florida-based cleft and craniofacial clinic. Additionally, data from the PHIS database were analyzed to investigate national factors affecting the age of alveolar bone grafting (ABG).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Craniofacial team in Florida<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients\/Participants<\/jats:title>\n                    <jats:p>The survey included 39 orthodontists (7.1% response rate) and 48 caregivers (41% response rate) The PHIS study included 1182 patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Barrier to orthodontic care and age of ABG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Orthodontic Survey<\/jats:italic>\n                      : Among the surveyed orthodontists, 71% treated cleft\/craniofacial patients, 37% accepted Medicaid, and 55% provided pro-bono care. Poor reimbursement was identified as the most common barrier (58%).\n                      <jats:italic toggle=\"yes\">Caregiver Survey<\/jats:italic>\n                      : Most patients were insured by Medicaid (67%), with 55% incurring out-of-pocket expenses.\n                      <jats:italic toggle=\"yes\">PHIS Database<\/jats:italic>\n                      : The average age of ABG was 10.3 years (SD\u2009=\u20093.2). Government funding was associated with a 6.0-month delay in ABG (p\u2009=\u20090.047) and residing in non-Medicaid expanded states was linked to a 6.0-month delay (p\u2009=\u20090.023). Post-Medicaid expansion status was also associated with a delay (p\u2009=\u20090.004)\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Access to oral care is difficult for patients with OFC. Despite both federal and state mandates, many financial and non-financial barriers still exist in accessing orthodontic care and a majority of patients experience significant out-of-pocket expenses despite statutorily mandated insurance coverage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656241284721","type":"journal-article","created":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T03:03:32Z","timestamp":1726715012000},"page":"1888-1900","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Barriers in Accessing Orthodontic Care for Patients with Orofacial Clefts: Insights from a Florida-Based Survey and National Database Analysis"],"prefix":"10.1177","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3632-4205","authenticated-orcid":false,"given":"Molly F.","family":"MacIsaac","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua M.","family":"Wright","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6829-8865","authenticated-orcid":false,"given":"Nicole K.","family":"Le","sequence":"additional","affiliation":[{"name":"University of South Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleshia J.","family":"Pringle","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay A.","family":"Schuster","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew B.","family":"Brown","sequence":"additional","affiliation":[{"name":"Dr. Andrew Brown Orthodontics, Orange Park, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"II","given":"William L.","family":"Kochenour","sequence":"additional","affiliation":[{"name":"Dr. William L. Kochenour II Orthodontics, Clearwater, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taryl O.","family":"Crisp","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5513-5162","authenticated-orcid":false,"given":"Jordan N.","family":"Halsey","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7209-1966","authenticated-orcid":false,"given":"S.","family":"Alex Rottgers","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,9,19]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2017.07.004"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3182043af6"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23329"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.1589"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.20522"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/003335490912400315"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2009.09.019"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656211046815"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665618822235"},{"key":"e_1_3_2_11_2","unstructured":"Standards of Approval for Team Care. ACPA Web site. https:\/\/acpacares.org\/standards-of-approval-for-team-care\/. Updated 2023. Accessed Jan 7 2024"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1597\/15-173"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221097813"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656211073049"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajodo.2021.01.033"},{"key":"e_1_3_2_16_2","unstructured":"Medicaid: A Primer - Key Information on the Nation\u2019s Health Coverage Program for Low-Income People. https:\/\/www.kff.org\/medicaid\/issue-brief\/medicaid-a-primer\/. Accessed Jan 7 2024"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2019.12.017"},{"key":"e_1_3_2_18_2","unstructured":"Status of State Medicaid Expansion Decisions: Interactive Map. 2024. https:\/\/www.kff.org\/medicaid\/issue-brief\/status-of-state-medicaid-expansion-decisions-interactive-map\/. Accessed Jan 7 2024"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665620910529"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665617736765"},{"key":"e_1_3_2_21_2","unstructured":"Medicaid and CHIP Scorecard - Medicaid Per Capita Expenditures. Medicaid.gov Web site. https:\/\/www.medicaid.gov\/state-overviews\/scorecard\/measure\/Medicaid-Per-Capita-Expenditures?pillar=4&measure=EX.5&measureView=state&stratification=463&dataView=pointInTime&chart=map&timePeriods=%5B%222021%22%5D. Updated 2021. Accessed Jul 1 2024"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0b013e31829aca3c"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1597\/1545-1569_2002_039_0018_abgipw_2.0.co_2"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0300-9785(85)80071-5"},{"issue":"3","key":"e_1_3_2_25_2","first-page":"175","article-title":"Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment","volume":"23","author":"Bergland O","year":"1986","unstructured":"Bergland O, Semb G, Abyholm FE. Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment. Cleft Palate J. 1986;23(3):175\u2010205. https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3524905","journal-title":"Cleft Palate J."},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665617738401"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-019-02977-y"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665620913024"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2015.0000"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1597\/06-233.1"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1597\/04-100r.1"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.14219\/jada.archive.2004.0216"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1597\/07-187.1"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajodo.2020.05.007"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2017.00221"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajodo.2007.05.011"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare10081555"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1177\/1465312518823010"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.17219\/dmp\/125874"},{"issue":"10","key":"e_1_3_2_40_2","first-page":"569","article-title":"JCO Orthodontic practice study part 1: Trends","volume":"53","author":"Keim RG","year":"2019","unstructured":"Keim RG, Vogels Iii DS, Vogels PB. 2019 JCO Orthodontic practice study part 1: Trends. J Clin Orthod. 2019;53(10):569\u2010587. https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/32058324","journal-title":"J Clin Orthod."},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1111\/jphd.12006"},{"issue":"5","key":"e_1_3_2_42_2","first-page":"380","article-title":"Evaluation of potential strategies to increase provider participation in Florida's dental medicaid program","volume":"42","author":"Arevalo O","year":"2020","unstructured":"Arevalo O, Sears L, Saman D, Roldan R. Evaluation of potential strategies to increase provider participation in Florida's dental medicaid program. Pediat Dentist. 2020;42(5):380\u2010386. https:\/\/www.ingentaconnect.com\/content\/aapd\/pd\/2020\/00000042\/00000005\/art00009","journal-title":"Pediat Dentist"},{"key":"e_1_3_2_43_2","unstructured":"Medicaid eligibility and enrollment in Florida. healthinsurance.org Web site. https:\/\/www.healthinsurance.org\/medicaid\/florida\/. Updated 2023. Accessed Jan 7 2024"},{"issue":"4","key":"e_1_3_2_44_2","first-page":"227","article-title":"Barriers to health care for children. How's Florida doing?","volume":"78","author":"Neiberger RE","year":"1991","unstructured":"Neiberger RE. Barriers to health care for children. How's Florida doing? Journal of the Florida Medical Association (1974). 1991;78(4):227.","journal-title":"Journal of the Florida Medical Association (1974)"},{"key":"e_1_3_2_45_2","unstructured":"The 2023 Florida Statutes. 627.64193: Required coverage for cleft lip and cleft palate. Online Sunshine Web site. http:\/\/www.leg.state.fl.us\/Statutes\/index.cfm?mode=View%20Statutes&SubMenu=1&App_mode=Display_Statute&Search_String=cleft&URL=0600-0699\/0627\/Sections\/0627.64193.html. Updated 2023. Accessed Jan 7 2024"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1177\/10775587221108751"},{"key":"e_1_3_2_47_2","unstructured":"Garfield R Hinton E Cornachione E Published CH. Medicaid managed care plans and access to care - provider networks and access to care - 9167. 2018:1\u201028."},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221074523"},{"key":"e_1_3_2_49_2","unstructured":"Paradise J Published RG. What is medicaid's impact on access to care health outcomes and quality of care? Setting the record straight on the evidence - issue brief. 2013:1\u201012. https:\/\/www.kff.org\/report-section\/what-is-medicaids-impact-on-access-to-care-health-outcomes-and-quality-of-care-setting-the-record-straight-on-the-evidence-issue-brief\/. Accessed Jun 26 2024."},{"key":"e_1_3_2_50_2","unstructured":"The 2023 Florida Statutes. 466.0285: Proprietorship by nondentists. http:\/\/www.leg.state.fl.us\/statutes\/index.cfm?mode=View%20Statutes&SubMenu=1&App_mode=Display_Statute&Search_String=466.0285&URL=0400-0499\/0466\/Sections\/0466.0285.html. Updated 2023. Accessed Jan 7 2024"},{"key":"e_1_3_2_51_2","doi-asserted-by":"publisher","DOI":"10.1177\/1055665619866363"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000009524"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2015.09.003"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.1597\/06-054"},{"key":"e_1_3_2_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/0278-2391(91)90172-I"},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9416(76)90258-X"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221104937"},{"key":"e_1_3_2_58_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-30770-6_49"}],"container-title":["The Cleft Palate Craniofacial Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656241284721","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10556656241284721","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656241284721","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T16:21:21Z","timestamp":1777393281000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10556656241284721"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,19]]},"references-count":57,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1177\/10556656241284721"],"URL":"https:\/\/doi.org\/10.1177\/10556656241284721","relation":{},"ISSN":["1055-6656","1545-1569"],"issn-type":[{"value":"1055-6656","type":"print"},{"value":"1545-1569","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,19]]}}}