The implementation of the Handicapping Labio‐Lingual Deviation index on access to orthodontic care

Abstract

Objectives In 2017, the state of Illinois changed the system by which they define severe malocclusion from the DentaQuest Orthodontic Criteria Index to the Handicapping Labio‐Lingual Deviation Index (HLD). The purpose of this study was to compare subjects who were submitted for coverage under either the DentaQuest Orthodontic Criteria Index or the HLD index to see if a difference exists in the number of subjects who received coverage and the type of malocclusions that were covered. Methods All subjects evaluated for orthodontic coverage by the Illinois Department of Human Services for treatment at the University of Illinois, College of Dentistry during the years 2016 and 2017 were included in this study. One hundred consecutively approved and 100 consecutively denied subjects from both 2016 and 2017 were selected for further analysis. Results There was a statistically significant decrease in the overall rate of approval in 2017 compared to 2016. No difference was found in the approval rate of Class I, II, or III subjects, but there was a significant decrease in the approval rate of subjects with impacted teeth. Conclusions The implementation of the HLD index has significantly decreased access to orthodontic care for Medicaid patients in Illinois.

Assessment of Handicapping Labio‐Lingual Deviation index scoring methods and their effect on orthodontic treatment coverage by Medicaid

“…Limited access to care has been recognized as the main issue for Medicaid patients from low‐income families [16]. Eligibility for orthodontic treatment was known determined by Medicaid using occlusal indices [13,14,27], which give assessment data related to the treatment needs and the severity of malocclusion through objective and quantitative evaluations [12]. However, our results showed the unknown underlying factors apart from the HLDI score that MCO uses to justify the eligibility for orthodontic coverage.…”

“…The finding showed there is inconsistency by the state of Illinois MCO in determining the patients' eligibility for orthodontic treatment coverage. Furthermore, a recent study concluded that after MCO implemented the HLDI as an assessment method, the rate of orthodontic treatment eligibility decreased in Illinois, restricting access to affordable orthodontic care for Medicaid-eligible children [13]. some states modified the HLDI and required less score for coverage Beglin et al (2001) suggested using 12 points as a cutoff for HLDI with California modifications (CalMod) instead of 26, which was determined to be too stringent [24].…”

“…The use of the HLD index calculated by VI to determine approval for orthodontic coverage has been increasing nationwide, However, the validity and reliability of the HLD index score calculated by VI have not been studied. Furthermore, a recent study showed that implementing the HLD index has significantly decreased access to orthodontic care for Medicaid patients in Illinois [13].…”

“…One of the commonly applied indices in determining eligibility for orthodontic care and treatment under the Medicaid program is the HLDI [13,14]. In January 2017, Illinois joined 35 other states and began utilizing the HLDI to assess orthodontic treatment need for all Medicaid patients and determine their Medicaid coverage eligibility for orthodontic treatment; the threshold for Medicaid eligibility in Illinois is an HLDI score of 28 [11].…”

“…Medicaid evaluators typically use the visual inspection (VI) method to calculate a patient's HLDI from intraoral photographs and the cephalometric radiograph [11]. However, compared to measurements taken on the digital models (DM), the accuracy of measurements determined through intraoral photographs is significantly lower due to potential camera angulation errors associated with them [10][11][12][13][16][17][18][19]. Consequently, it is possible that Medicaid's decision-making on eligibility for orthodontic treatment coverage (eligible/not eligible) is affected by the scoring method.…”