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There are very few nationwide studies discussing the height, weight, head circumference, and dental screening of children with cleft lip with or without palate (CL/P), with most reports on this subject based on a 1900s cohort. This study aimed to characterize CL/P children in the 2000s in terms of height, weight, head circumference, and dental screening. This nationwide population-based study evaluated the National Health Insurance Service-Infants and Children's Health Screening (NHIS-INCHS), specifically the height, weight, and head circumference of millions of children. Dental screening data, including the status of each tooth and comprehensive dental judgment, were also evaluated. Syndromic and nonsyndromic CL/P children had lower height, weight, and head circumference than no CL/P children until the age of 66–71 months. Children with cleft palate only or both cleft lip and palate showed similar results. Regarding dental screening, the primary teeth of CL/P children erupted later and fell out faster than no CL/P children. Dental caries was also more common in CL/P children. Children with CL/P had inferior general growth, regardless of palatoplasty surgery. More aggressive dental treatment was required for CL/P children due to the instability of primary teeth and tendency for caries. [ABSTRACT FROM AUTHOR] more...

The article focuses on the Texas Dental Association's (TDA) advocacy for Medicaid and CHIP, emphasizing the importance of maintaining and strengthening the dental public health safety net. Topics include TDA's efforts to prevent funding reductions, review Medicaid preventive dental policy, and ensure dentist concerns are addressed in various programs and committees to enhance dental care access and quality for Medicaid and CHIP participants. more...

COVID-19 has disproportionately affected healthcare access of certain minority groups, and thus could contribute to delay in timely evaluation and management of pediatric obstructive sleep apnea (OSA). Socioeconomic status (SES) is known to affect healthcare access in pediatric otolaryngology and may also be a risk factor for OSA and its associated co-morbidities. Our primary objective is to determine the impact of COVID-19 on time to diagnosis (TTD) and time to treatment (TTT) of polysomnography (PSG)-proven moderate to severe pediatric OSA in different socioeconomic classes. Secondary objectives include determining the impact of racial and demographic factors on TTD and TTT. This is a retrospective chart review of 120 children; 60 children pre-COVID (February 2018 to February 2020), and 60 children post-COVID onset (March 2020 to March 2022). This study was performed at a pediatric teaching hospital and tertiary referral center, and involved children aged 3–17 years old with outpatient PSG-proven moderate to severe OSA. Approval was obtained from our hospital's institutional review board (IRB). There were a total of 120 children, 60 in each group. The average age was 9.5 years old; females constituted 41.6 % of the sample. TTD increased from 53.7 days pre-covid to 103 days post-COVID onset in all children (p = 0.00), 42.5 days–151.9 days in white children (p = 0.00), 38 days–142.7 days in children with high SES (p = 0.00), 32.1 days–146.5 days in children with private insurance (p = 0.00), and 65.7 days–105.8 days in children with public insurance (p = 0.04). TTT did not change significantly. Our results show that TTD of OSA and obesity in advantaged groups were affected to a greater degree than disadvantaged groups. This suggests children of all socioeconomic groups are susceptible to healthcare disparities and the COVID-19 pandemic has uncovered the vulnerability of such populations. Policymakers should consider providing more funding and support for all children, including continued funding for those with lower SES. [ABSTRACT FROM AUTHOR] more...

Medicaid and the Children's Health Insurance Program (CHIP) both combine federal mandates to cover certain services and groups with state options in providing that coverage and in covering other services and groups. Using state‐level panel data, we investigated the relationships of 83 state Medicaid and CHIP options with 2 child insurance outcomes from 2008 to 2018 using structural equation modeling, controlling for 10 possible demographic and economic variables, state fixed effects, and a quadratic year count variable. Our results suggest that eliminating asset tests for children's and parents' coverage, eliminating or reducing waiting periods for children's coverage, providing express and continuous eligibility for children's coverage, and eliminating face‐to‐face interview requirements for children's coverage may have been especially important in reducing child uninsurance rates and increasing the percentage of children covered by means‐tested public insurance. Key points: Eliminating asset tests for children's and parents' coverage may have been especially important in reducing child uninsurance rates in the United States from 2008 to 2018.Eliminating or reducing waiting periods for children's coverage may have been another important state option in reducing child uninsurance rates.Providing express and continuous eligibility for children's coverage may also have been important in reducing child uninsurance rates.Eliminating face‐to‐face interview requirements for children's coverage may also have helped to reduce child uninsurance rates. [ABSTRACT FROM AUTHOR] more...

Oral health is usually excluded or not considered part of primary healthcare, especially for adults. Disparities in oral health are more likely to impact low-income, uninsured, ethnic minorities, immigrants, or rural populations who have no access to quality oral health. Medicaid and the Children's Health Insurance Program (CHIP) provide medical and dental services for free or low cost to over 72.5 million Americans; however, adults are excluded from the dental benefits. Under the Affordable Care Act (ACA), 39 states have adopted the Medicaid expansion intending to include dental benefits in their alternative benefit plan (ABP) for eligible adults up to 138% of the federal poverty level (FPL). Nevertheless, the twelve states that have not adopted the Medicaid expansion leave over 2 million adults without dental coverage. The disadvantaged and underserved communities are at a higher risk for periodontal disease and decay due to social factors that include poor nutrition, lack of preventive oral health, alcohol and tobacco use, and oral cancer in older adults. Periodontal disease can cause adverse systemic conditions, and systemic diseases can cause periodontal disease. This issue leaves the disadvantaged and underserved adults in pain, ill from infections, in need of extractions, and facing detrimental effects on their health and quality of life. [ABSTRACT FROM AUTHOR] more...

We investigate the gap in welfare use between immigrants and natives over a 24-year period using the Annual Social and Economic Supplement of the Current Population Survey from 1995 to 2018, spanning periods of economic recessions and recoveries, changes in welfare policy regimes, and policies towards immigrants. A novel contribution of our research is to adopt the Oaxaca–Blinder decomposition analysis to study the effects of demographic factors, macroeconomic trends and policy on welfare use gap between immigrants and natives. Our analysis leads to three main findings: one, if immigrants had the same demographic characteristics as natives their participation in means-tested programs would have been much less overall and much below those of natives. This finding holds true across broader measures of welfare receipt capturing cash and near cash programs and health insurance as well as participation in five specific safety net programs. It also holds true across periods of economic recessions and recovery. Second, we find evidence that the business cycle impacts immigrant and native welfare participation differently. Immigrant participations in Temporary Assistance to Needy Families, Supplemental Nutritional Assistance Program and State Children's Health Insurance Program are more sensitive to the business cycle than native participations. Three, we find that changes in program eligibility explain only a modest proportion of the immigrant-native gap in welfare use. A possible explanation for this finding is that changes in eligibility rules have affected only specific immigrant populations (e.g. new immigrants) whereas our analysis pertains to all immigrants. [ABSTRACT FROM AUTHOR] more...

Background: Parents of children with rare diseases often face uncertainty about diagnosis, treatment, and costs associated with healthcare for their child. Health insurance status impacts each of these areas, but no U.S. study has explored parents' perceptions of the health insurance impacts on their child's care. This study aimed to qualitatively explore how these parents navigate the complex health insurance system for their children and their experiences in doing so.Methods: Semi-structured interviews were conducted with parents of children with metachromatic leukodystrophy (MLD) and spinal muscular atrophy (SMA), chosen for specific disease characteristics and orphan drug status. Participants were recruited via e-mail through patient advocacy organizations between September and December 2018. Interviews were conducted via Skype, were recorded, and professionally transcribed. Modified grounded theory was utilized as a methodology to analyze transcripts in an iterative process to determine themes and sub-themes based on participant described experiences.Results: Major themes and subthemes that emerged across the 15 interviews included: (1) difficulties obtaining secondary insurance based on state eligibility criteria; (2) difficulty accessing needed healthcare services; and (3) need for repeated interactions with insurance representatives. The absence of clearly documented or widely recognized clinical guidelines exacerbated the difficulty accessing care identified as necessary by their healthcare team, such as therapy and equipment. An explanatory model for parent's experiences was developed from the themes and subthemes. The model includes the cyclical nature of interacting with insurance for redundant reauthorizations and the outside support and financial assistance that is often necessary to address their child's healthcare needs.Conclusions: With complex health conditions, small setbacks can become costly and disruptive to the health of the child and the life of the family. This study suggests that patients with rare diseases may benefit from time limits for processing coverage decisions, increasing transparency in the claims and preauthorization processes, and more expansive authorizations for on-going needs. Additional studies are needed to understand the full scope of barriers and to inform policies that can facilitate better access for families living with rare diseases. [ABSTRACT FROM AUTHOR] more...

This article describes the study to assess the benefits provided by the Health Law Partnership (HeLP), a medical-legal partnership (MLP), to pediatric patients with neuro-developmental disabilities and their families. The study is a descriptive analysis that examines legal, social, and health issues addressed and outcomes attained through inter-professional collaboration among healthcare providers and lawyers to address health-harming legal issues that exasperate families with children with neurodevelopmental disabilities who have complex medical needs. During the time period of January 1, 2006, to June 30, 2018, a retrospective cohort of families of 651 patients with 1.071 parent-reported neurodevelopmental disabilities were able to have their legal concerns addressed. Forty-seven percent of children served experienced developmental delays, 29 percent had ADHD, 23 percent had autism, and 14 percent were premature at birth. Of these children, 63 percent were male and 34 percent were ages 5-10 years. Families referred to HeLP received a legal check-up that is the legal equivalent to a medical history to assess legal problems/needs and financial eligibility (<200%). Legal cases were assigned to an inter-professional team of lawyers and law students through Atlanta Legal Aid and Georgia State University College of Law, and physicians and medical students associated with Children's Healthcare of Atlanta and Emory University and Morehouse Schools of Medicine. The most common legal problems addressed by HeLP among 457 cases receiving extended legal services were education (225; 25.1%), Supplemental Security Income (SSI) (189; 21%), and family law (166; 18.5 %). Benefits obtained/retained through legal services exceeded $4.9 million in total value over the life of the study. Medicaid, State Children's Health Insurance Program (SCHIP) and other health-related assistance resolved cases resulted in an average benefit value of $18,925 per case, followed by SSI and education cases with an average benefit value of $9,585 and $5,336, respectively. HeLP services resulted in improved access to education resources and also resulted in financial cost savings to families. Additionally, HeLP services provided cost savings to the healthcare system by securing entitlement benefits (Medicaid, SCHIP, SSI) for children with neurodevelopmental disabilities who may otherwise be subjected to indigent or charity care. In conclusion, inter-professional practice among healthcare and legal providers can result in more timely access to resources to address legal and other social determinants of health that exacerbate the complex needs of children with neuro-developmental disabilities and their families. Additionally, access to entitled benefits and resources result in short- and long-term cost savings to both families and systems. [ABSTRACT FROM AUTHOR] more...

Background: We aimed to examine how caregiver perceptions of primary care affects care-seeking prior to pediatric non-urgent ED visits.Methods: We performed a cross-sectional survey of caregivers of children presenting to a pediatric ED during weekday business hours and triaged as low acuity. We first compared caregiver sociodemographic characteristics, perceptions of primary care, and stated preference in care sites (ED vs PCP) for caregivers who had sought care from their child's PCP office versus had not sought care from their child's PCP office prior to their ED visit. We then examined odds of having sought care from their PCP office prior to their ED visit using multivariable logistic regression models sequentially including caregiver primary care perceptions and stated care site preferences along with caregiver sociodemographic characteristics.Results: Of 140 respondents, 64 (46%) sought care from their child's PCP office prior to presenting to the ED. In unadjusted analysis, children insured by Medicaid or CHIP, caregivers identifying as Black, and caregivers with lower educational attainment were less likely to have sought PCP care before presenting to the ED (p < 0.005, each). Caregivers who had sought PCP care were more likely to prefer their PCP relative to the ED in terms of ease of travel, cost, and wait times (p < 0.001, all). When including these stated preferences in a multivariable model, child insurance, caregiver race, and caregiver education were no longer significantly associated with odds of having sought PCP care prior to their ED visit.Conclusions: Differential access to primary care may underlie observed demographic differences in non-urgent pediatric ED utilization. [ABSTRACT FROM AUTHOR] more...

Background: Exacerbation of asthma symptoms increases the likelihood of emergency department (ED) visits and hospitalizations. Because the ED is an important healthcare resource for immediate asthma care with acute exacerbations, we identify those populations most likely to seek ED treatment for asthma and describe the asthma burden for post-ED visit hospitalizations and critical care units. Methods: We examined the characteristics of asthma-related ED visits and hospital admissions and assessed the association between them using multivariable logistic regression models by analyzing data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) during 2010–2015. Results: Of all ED visits, 1.32% were asthma-related; of all ED visits that resulted in hospitalization, 1.12% were asthma-related and, of all ED visits that resulted in admission to a critical care unit, 1.20% were asthma related. The percentages of asthma-related ED visits and post-ED hospitalizations (H) were greater among children (adjusted prevalence ratio: ED: 2.28 [1.96.29–2.65]; H: 8.75 [5.93–12.92]) than among adults and greater for blacks (ED: (2.26 [1.97–2.60]; H: 3.25 [2.07–5.12]) and Hispanics (ED: (1.74 [1.47–2.08]; H: 2.424 [1.46–4.00]) than for whites. The percentage of ED visits was also greater for those covered by Medicaid or the Children's Health Insurance Program (CHIP) than by private insurance. Conclusions: Both asthma-related ED visits and post-ED hospitalizations were greater for children, blacks, and Hispanics. ED visits were also greater for Medicaid/CHIP. These findings might help prompt future studies on identifying additional potential risk factors for frequent ED visits among disproportionally affected subpopulations. [ABSTRACT FROM AUTHOR] more...

Purpose: Our purpose was to survey nationwide radiation oncology practices on their participation in, burden of, and satisfaction with the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015 (MACRA) payment programs.Methods and Materials: All radiation oncology practices accredited by a national specialty organization were invited to participate in a voluntary online survey from December 2018 to January 2019. Questions focused on participation in the Merit-based Incentive Payment System (MIPS) in 2017 and 2018, as by the time of this survey, radiation oncology did not yet have a specialty-specific advanced Alternative Payment Model.Results: Of n = 705 solicited practices, n = 199 completed the survey for an overall response rate of 28.2%. Practices varied significantly in their duration of participation in MACRA programs, means of data submission, and reported improvement activities under MIPS. Forty-nine percent of respondents described being either somewhat or extremely dissatisfied with the ease of submitting measures and data in 2018. The estimated cost to the practices of compliance with MACRA was queried in bins; of users able to estimate the cost of compliance for 2018, the median reported bin was $10,001 to $20,000 (range, less than $1000-100,000 or more).Conclusions: The participation style in MACRA among radiation oncology practices varied substantially in the years 2017 and 2018. The Center for Medicare & Medicaid Services gave no precise estimates on the cost of compliance for MIPS, but estimated a $3019.47 cost of compliance with the mandated Radiation Oncology Alternative Payment Model in the 2020 Final Rule for selected practices. In this survey, respondents commonly reported the cost of compliance with MACRA significantly exceeded this estimate. [ABSTRACT FROM AUTHOR] more...

Union resistance to Medicare for All is fading as the employment-based healthcare system collapses but some unionists still believe that their unions will be stronger and more secure if they continue to negotiate basic healthcare benefits for their members. Keywords: health care; labor; neoliberalism; working class; trade unions EN health care labor neoliberalism working class trade unions 70 79 10 06/05/21 20210401 NES 210401 The industrialized world's most unequal and inefficient healthcare system underwent a stress test this past pandemic year and failed miserably. If unions no longer had to bargain for basic health care for their members, monies would be freed up to negotiate real "union advantage" benefits like paid family leave, child and elder care that could help launch a revitalized labor movement. B I A central element of the U.S. healthcare system's catastrophic failure in the face of the pandemic is its linkage to employment. i b As unions in much of the rest of the industrialized world were leading the fight to construct robust publicly funded universal healthcare systems that treated health care as a right available to all, the U.S. labor movement helped to craft a "second best solution" that turned health care into a benefit linked to employment. [Extracted from the article] more...

In this paper, I show that fiscal structure can have large effects on the ability of safety net programmes to provide benefits. I examine the response of child enrolment in Medicaid, which is funded through a matching grant, and enrolment in the State Children's Health Insurance Program (SCHIP), which is funded through a block grant, to business cycle fluctuations. I find that while child Medicaid enrolment is relatively acyclical, a one percentage point increase in the unemployment rate decreases SCHIP enrolment per child by 6.3%, and a 1% decrease in gross state product (GSP) or GSP growth decreases enrolment in SCHIP by approximately 1%, suggesting block grant funding reduces the ability of safety net programmes to respond to macroeconomic fluctuations. [ABSTRACT FROM AUTHOR] more...

Purpose: Home food environment, including home food availability and parental food preparation practices, plays a significant role in child diet patterns. Recent evidence suggests that parental psychological stress is related to parental food preparation practices; however, there is limited information about the relationship between parental psychological stress and home food availability. The purpose of the study is to examine the relationships between parental stress, home food availability, child diet patterns, and body mass index (BMI) in families with young children. Design: A secondary data analysis from a mixed-methods design study. Setting: The parent study was conducted in both local and online communities using a web-based survey. Participants: Participants were 256 parents of children aged 2 to 5 years (53.4% white; 41.5% of overweight or obese children). Measures: Parents completed well-validated self-report questionnaires. Analysis: We used latent structural equation modeling using Bayesian analysis. Results: There was a negative relationship between parents' general stress and healthy food availability at home (β* = −.20, P <.001 for fruits; β* = −.23, P <.001 for vegetables; and β* = −.24, P <.001 for healthy beverage) and a positive relationship between parenting stress and healthy snack and healthy beverage availability (β =.13, P =.03; β =.14, P =.02, respectively). There was no relationship between parental stress and unhealthy food availability at home while unhealthy food availability was significantly associated with child's unhealthy eating pattern (β* =.86, P <.01 for unhealthy snack; β* =.51, P <.01 for unhealthy beverage). There was no moderating effect of children's health insurance on the relationships between parental stress and home food availability. Furthermore, child diet patterns were not associated with child BMI. Conclusion: Parental psychological stress is a potentially important intervention target point for improving home food environment and child diet patterns. [ABSTRACT FROM AUTHOR] more...