Utilization of Medical and Dental Services for Children and Adults with Intellectual/Developmental Disabilities

This study focused on the utilization of medical and dental services by Iowa children and adults enrolled in Medicaid who have an intellectual and/or a developmental disability (IDD). Another focus was the receipt of preventive and routine medical and dental services, services that can be overlooked when focusing on emergent needs.

The study was designed to answer the following questions:

• What is the utilization of routine medical and dental services for Iowa’s Medicaid enrolled children and adults identified as having IDD?
• How does the utilization of routine medical and dental services for Iowa’s Medicaid enrolled children and adults identified as having IDD compare to non-IDD populations or other established benchmarks for dental and medical utilization?

Medicaid enrollees were identified as having IDD if they met one of four criteria:

1. had at least one Medicaid claim with an identified IDD diagnosis code during the period January 1, 2001 through December 31, 2005;
2. had at least one claim for targeted case management for mental retardation or developmental disability;
3. resided in an Intermediate Care Facility for people with Mental Retardation (ICFMR) or State facility for people with Mental Retardation (SMR);
4. or had an enrollment exception indicator to allow special services for mental retardation or developmental disability.

Using these criteria, we identified 18,831 Medicaid enrollees with MRDD who were eligible for at least 11 months during calendar year (CY) 2005. Fifty-six percent were male, 48% lived in a metropolitan county, 78% lived in the community, 64% had received targeted case management in the last year, and 59% were eligible for Medicaid through the HCBS waiver.

Utilization of routine ambulatory care was the same for adults with IDD and those without, however, children 3-6 years of age without IDD were more likely to receive a well-child visit than those with IDD. Results were slightly different for dental care. Children ages 1-3 with IDD were more likely to have a dental visit than those without IDD, while those 4-11 were less likely to have a dental visit. The adult dental visit rate was high, at over 80%, for adults with IDD.

Males were more likely to receive routine ambulatory or preventive care than females among children, while this reversed itself among adults. Over 80% of adults with a case manager received ambulatory care, however, approximately 50% of children with a case manager received well care. Generally, children and adults in metropolitan areas are more likely to receive well care or ambulatory care. Dental utilization was related to age with the youngest children and the most elderly the least likely to receive a preventive dental visit, though diagnostic rates were virtually equal among adults. Children and adults living in an institution were more likely to receive dental services than those residing in the community. Living in a metropolitan area also seemed to positively influence whether an enrollee had a dental visit or not.

The study was mandated by the Iowa Legislature in House File 841 passed in 2005.