title: Dental Homes for Children With Autism: A Longitudinal Analysis of Iowa Medicaid's I-Smile Program.
abstract: BACKGROUND
  Medicaid-enrolled children with autism spectrum disorder (ASD) encounter significant barriers to dental care. Iowa's I-Smile Program was implemented in 2006 to improve dental use for all children in Medicaid. This study compared dental home and preventive dental utilization rates for Medicaid-enrolled children by ASD status and within three time periods (pre-implementation, initial implementation, maturation) and determined I-Smile's longitudinal influence on ASD-related dental use disparities.
  
  
  METHODS
  Data from 2002-2011 were analyzed for newly Medicaid-enrolled children aged 3-17 years (N=30,059); identified each child's ASD status; and assessed whether the child had a dental home or utilized preventive dental care. Log-linear regression models were used to generate rate ratios. Analyses were conducted in 2015.
  
  
  RESULTS
  In 2003-2011, 9.8% of children with ASD had dental homes compared with 8% of children without ASD; 36.3% of children with ASD utilized preventive care compared to 45.7% of children without ASD. There were no significant differences in dental home rates by ASD status during pre-implementation, initial implementation, or maturation. There were no significant differences in preventive dental utilization by ASD status during pre-implementation or initial implementation, but children with ASD were significantly less likely to utilize preventive care during maturation (rate ratio=0.79, p<0.001). Longitudinal trends in dental home and preventive dental utilization rates were not significant (p=0.54 and p=0.71, respectively).
  
  
  CONCLUSIONS
  Among newly Medicaid-enrolled children in Iowa's I-Smile Program, those with ASDs were not less likely than those without ASD to have dental homes but were significantly less likely to utilize preventive dental care.
authors.affiliation: Department of Oral Health Sciences, University of Washington, Seattle, Washington. Electronic address: dchi@uw.edu.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Chi
authors.affiliation: Public Policy Center, University of Iowa, Iowa City, Iowa.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Momany
authors.affiliation: Department of Oral Health Sciences, University of Washington, Seattle, Washington.
authors.forename: Lloyd A
authors.initials: LA
authors.lastname: Mancl
authors.affiliation: Department of Pediatrics, University of Iowa, Iowa City, Iowa.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Lindgren
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Zinner
authors.affiliation: Department of Neurology, University of Washington, and Seattle Children's Research Institute, Seattle, Washington.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Steinman
mesh_terms: D000293:Adolescent; D001321:Autistic Disorder / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D003190:Comprehensive Dental Care / Q000706:statistics & numerical data; D003729:Dental Care / Q000706:statistics & numerical data*; D019140:Dental Care for Children / Q000706:statistics & numerical data*; D003777:Dental Prophylaxis / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007484:Iowa; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid; D014481:United States