National Disparities in Insurance Coverage of Comprehensive Craniomaxillofacial Trauma Care
Vikas S. Kotha, MD1; Brandon J. de Ruiter, MD1, Marvin Nicoleau BA2, Edward. H. Davidson MD1
1Department of Plastic Surgery, University Hospitals-Case Western Reserve University; Cleveland, OH, 2Case Western Reserve University School of Medicine; Cleveland, OH
Background: Comprehensive craniomaxillofacial trauma care includes correcting functional deficits, addressing acquired deformities and appearance, and providing psychosocial support. The aim of this study is to characterize insurance coverage of surgical, medical, and psychosocial services indicated to manage common functional, appearance-related, and psychosocial sequelae of facial trauma and highlight national discrepancies in policy
Methods: A cross-sectional analysis of insurance coverage was performed for treatment of common functional, appearance, and psychosocial facial trauma sequelae. Policies were given 3 points for coverage, 2 points for case-by-case coverage, 1 point for no mention, or 0 points for explicit exclusion. The sum of earned points determined coverage scores (CS) for functional sequelae (FSCS), acquired-appearance sequelae (ASCS), and psychosocial sequelae (PSCS). The sum of these scores generated a Comprehensive Coverage Score (CCS)
Results: Nationally, Medicaid earned lower CCSs and PSCSs than private insurance (p=0.02, p=0.02) Medicaid CCSs were lowest in Oklahoma, Arkansas, and Missouri. Private policy CCSs and PSCSs were highest in Colorado and Delaware and lowest in Wisconsin. California and Florida earned the highest and lowest Medicaid PSCSs, respectively. FSCSs and ASCSs were similar for Medicaid and private policies. Medicaid coverage scores were higher in states that opted-into Medicaid expansion (p=0.04), states with Democrat governors (p=0.02), states with mandated paid leave (p=0.01), and states with >40% total population living >400% above federal poverty (p=0.03). Medicaid coverage scores for comprehensive CMF care and psychosocial sequelae were lower in southeastern states compared to the rest of the country. Private policy coverage scores for comprehensive CMF care, functional sequelae care, and appearance-related care were lower in Midwestern states than the rest of the country
Conclusion: Insurance disparities in comprehensive craniomaxillofacial care coverage exist, particularly for psychosocial services. The disparities correlate with current state-level geopolitics. There is a uniform need to address national and state-specific differences in coverage from both Medicaid and private insurance policies.
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