{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T08:36:27Z","timestamp":1792917387328,"version":"4.5.0"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"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"],"abstract":"\n Objective<\/jats:title>\n To analyze the association between Medicaid provider reimbursement for cleft lip and palate (CL\/P) procedures and state-level economic factors.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Cross-sectional study of publicly available 2025 state Medicaid provider reimbursement rates associated with CL\/P procedures. Statistical analysis compared provider reimbursement and demographic factors.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n National sample of Medicaid reimbursement fee schedules.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Fifty U.S. states utilizing fee-for-service reimbursement.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measure(s)<\/jats:title>\n Reimbursement Rates for D8020 (Phase I: Limited Orthodontia, Transitional Dentition) and D8080 (Phase II: Comprehensive Orthodontia, Adolescent Dentition), CPT 42210 (Palatoplasty for Cleft Palate with Bone Graft), Pediatric Population of Medicaid and Children's Health Insurance Program.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n D8080 reimbursement was negatively correlated with pediatric Medicaid enrollment (\n r\u2009=\u2009<\/jats:italic>\n \u20130.375,\n p\u2009=\u2009<\/jats:italic>\n 0.014). Multivariate linear regression predicted D8080 reimbursement, explaining 46.9% of variance (adjusted R\n 2<\/jats:sup>\n \u2009=\u20090.41). Higher reimbursement was associated with higher cost of living (\u03b2\u2009=\u20090.39,\n p\u2009=\u2009<\/jats:italic>\n 0.007), poverty (\u03b2\u2009=\u20090.51,\n p\u2009<\u2009<\/jats:italic>\n 0.001), and Medicaid expansion (\u03b2\u2009=\u20090.27,\n p\u2009=\u2009<\/jats:italic>\n 0.041), but lower in states with greater pediatric enrollment (\u03b2\u2009=\u2009\u20130.53,\n p\u2009<\u2009<\/jats:italic>\n 0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Medicaid provider reimbursement for comprehensive orthodontic treatment is independently associated with state socioeconomic characteristics. Reimbursement decreased with higher enrollment. This trend may further limit provider availability for low-income families with existing barriers in access to care. These findings suggest that Medicaid reimbursement may not adequately scale with pediatric beneficiary demand, potentially limiting access to multidisciplinary treatment.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/10556656261499060","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:50:16Z","timestamp":1792590616000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["When Need Exceeds Support: Lower Medicaid Reimbursement for Cleft Orthodontia in High Pediatric Enrollment States"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1607-7831","authenticated-orcid":false,"given":"Ronald R.","family":"McCall","sequence":"first","affiliation":[{"name":"University of Mississippi Medical Center School of Medicine","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashlie","family":"Elver","sequence":"additional","affiliation":[{"name":"University of Mississippi Medical Center","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0695-0952","authenticated-orcid":false,"given":"John David","family":"West","sequence":"additional","affiliation":[{"name":"University of Mississippi Medical Center School of Medicine","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0037-7935","authenticated-orcid":false,"given":"Hannah","family":"Benton","sequence":"additional","affiliation":[{"name":"University of Mississippi Medical Center School of Medicine","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0235-7798","authenticated-orcid":false,"given":"Kendall C.","family":"Pitre","sequence":"additional","affiliation":[{"name":"University of Mississippi Medical Center School of Medicine","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8332-2280","authenticated-orcid":false,"given":"Ian C.","family":"Hoppe","sequence":"additional","affiliation":[{"name":"University of Mississippi Medical Center","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura S.","family":"Humphries","sequence":"additional","affiliation":[{"name":"University of Mississippi Medical Center","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"key":"e_1_3_2_2_2","article-title":"Cleft palate","author":"Phalke N","year":"2025","unstructured":"Phalke N, Goldman JJ. Cleft palate. In: StatPearls. StatPearls Publishing; 2025. Accessed June 1, 2025. http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK563128\/","journal-title":"StatPearls"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jormas.2021.05.008"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jormas.2024.101899"},{"key":"e_1_3_2_5_2","unstructured":"kffrobinr. Two year trends in Medicaid and CHIP enrollment data: Findings from the CMS performance indicator project. KFF. June 24 2016. Accessed July 26 2026. https:\/\/www.kff.org\/medicaid\/two-year-trends-in-medicaid-and-chip-enrollment-data-findings-from-the-cms-performance-indicator-project\/"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-023-08558-w"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000009524"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.0294"},{"key":"e_1_3_2_9_2","unstructured":"Managed Care Contractors (MCCs). Accessed August 22 2025. https:\/\/www.tn.gov\/tenncare\/providers\/managed-care-contractors.html."},{"key":"e_1_3_2_10_2","unstructured":"Spears M. How Medicaid Works in Tennessee. The Sycamore Institute. June 1 2017. Accessed August 22 2025. https:\/\/sycamoretn.org\/what-is-tenncare\/."},{"key":"e_1_3_2_11_2","unstructured":"Federally Qualified Health Centers | NC Medicaid. Accessed August 22 2025. https:\/\/medicaid.ncdhhs.gov\/providers\/programs-and-services\/medical\/federally-qualified-health-centers."},{"key":"e_1_3_2_12_2","unstructured":"Rural Health Clinics | NC Medicaid. Accessed August 22 2025. https:\/\/medicaid.ncdhhs.gov\/providers\/programs-and-services\/medical\/rural-health-clinics."},{"key":"e_1_3_2_13_2","unstructured":"Status Indicators | CMS. Accessed August 23 2025. https:\/\/www.cms.gov\/status-indicators?utm_source=chatgpt.com."},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2025-075749"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14331"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2024.01530"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000002823"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2021.102541"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-019-05160-x"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.20522"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2024.a919815"},{"issue":"4","key":"e_1_3_2_22_2","first-page":"371","article-title":"Pediatric dentist density and preventive care utilization for Medicaid children","volume":"37","author":"Heidenreich JF","year":"2015","unstructured":"Heidenreich JF, Kim AS, Scott JM, Chi DL. Pediatric dentist density and preventive care utilization for Medicaid children. 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