MEDICAID FUNDING FOR ORTHODONTIC TREATMENT: AAO AUTO-QUALIFIERS COMPARED TO SALZMANN INDEX

Abstract

Objectives: Various indices exist to determine priority for orthodontic treatment need. The American Association of Orthodontists (AAO) Auto-Qualifiers (AQs) are proposed criteria to standardize treatment priority. We investigated how the AAO Auto-Qualifier criteria compares to the Salzmann Index (SI) for determining treatment need, and thus Medicaid funding for orthodontic treatment. Methods: 81 subjects were previously screened, with completed SI scores, at Temple University Kornberg School of Dentistry (TUKSoD) between December 2019 and February 2020. Records were analyzed using the AAO Auto-Qualifier criteria. AQ results were compared to funding decisions by Insurance Company A, one of the primary Medicaid insurance companies for patients seeking treatment at TUKSoD. Malocclusion characteristics for transverse (presence of posterior crossbite), vertical (presence of open bite or deep bite) and sagittal (Class I, II, or III or presence of anterior crossbite) dimensions were recorded when funding decisions were discrepant between Insurance Company A and the AQs. Results: Funding approval by Insurance Company A and potential approval based on the AAO AQs was found to be 37.04% and 44.44%, respectively. Funding agreement between the two assessments was 77.7% (Cohen’s kappa = 0.56). Disagreement occurred with malocclusion characteristics identified in all three dimensions, most often sagittal. Crowding or spacing ≥10mm (in either arch) and impinging overbite with evidence of occlusal contact into the opposing soft tissue were the two most common Auto-Qualifiers that resulted in funding approval. Crowding or spacing ≥10mm (in either arch) and anterior and/or posterior crossbite of ≥3 teeth per arch were the most common AAO AQs that disagreed with SI scores. Conclusions: There is a moderate level of agreement for determining Medicaid funding for orthodontic treatment between Insurance Company A (based on SI scores) and the proposed AAO AQs. Adopting the proposed AAO Auto-Qualifiers nationally may result in a greater number of approvals for Medicaid funding for patients seeking orthodontic treatment in states that utilize Salzmann Index scores for determining funding decisions.