Pediatric dental surgeries in children with intellectual disabilities and autism paid by means of Medicaid

BACKGROUND: Use of ambulatory surgery centers (ASCs) relative to hospital outpatient departments (HOPDs) for outpatient surgeries for caries in children with intellectual disabilities and related conditions (IDRC) and autism has not been characterized. METHODS: In this cross-sectional analysis of Medicaid data (2016-2020) from 40 states, the authors examined 601,286 outpatient dental surgeries performed in ASCs and HOPDs in children (1-18 years) with IDRC, with autism, and without IDRC or autism (IDRC/A), overall and according to race and ethnicity. Multivariable regression models estimated regression-adjusted probabilities of receiving care in ASCs. Models included year and state fixed effects and child-level clustered SEs. RESULTS: Among surgeries in ASCs and HOPDs, the regression-adjusted predicted probability of ASC use was 14.0 percentage points lower for children with IDRC (15.9%; P < .001) and 3.8 percentage points lower for children with autism (26.1%: P < .001) than for children without IDRC/A (29.9%). Racial and ethnic differences within disability groups were small. Among surgeries in ASCs and HOPDs, the probability of ASC use was 1.8 percentage points lower for Hispanic autistic children (P = .009) than White autistic children. Among children without IDRC/A who were treated in an ASC or HOPD, ASC use was 0.6 percentage points higher for Black children (P < .001) and 1.1 percentage points higher for Hispanic children (P = .001) than for White children. CONCLUSIONS: Children with IDRC and autism were less likely to receive care in ASCs than HOPDs than children without IDRC/A. PRACTICAL IMPLICATIONS: Because ASCs are less costly than HOPDs, providing more care at ASCs for children with IDRC and autism may help reduce costs for this population.