Methodology

Purpose:

In 2013 the Medicaid|Medicare|CHIP Services Dental Association (MSDA), (formerly the Medicaid-CHIP State Dental Association) established the National Profile of State Medicaid and CHIP Oral Health Programs. This online database represents a cross-sectional study design, which records a unique snapshot of the 50+ state Medicaid and CHIP oral health programs at a point in time. State information and data are collected annually from the states via the Annual MSDA Medicaid and CHIP Oral Health Program Survey Questionnaire. Each year a new survey is implemented and the corresponding national profile is published online representing the newly defined point in time.

The purpose of the MSDA National Profile of State Medicaid and CHIP Oral Health Programs is to display national, regional and state program information and data on all fifty states so that end users may assess specific program characteristics, policies, administrative practices, provider networks, benefit and payment structures and other key areas of interest. The collection contains descriptive, quantitative, and qualitative information and data.

The cross-sectional methodology is used by MSDA to collect information and data from the states because it is economical and similar to a census where information may be systematically acquired and recorded. In addition, it allows for comparisons within and across state programs, and helps to identify and assess program gaps, trends and best practices.

History:

In January 2010, the MSDA leadership met with federal policy makers from the Centers for Medicare and Medicaid Services (CMS) and the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB) to discuss ways in which the organization could potentially partner. During the meeting, federal partners expressed the need for a national database of State Medicaid and CHIP Oral Health Programs. Meeting attendees agreed that there existed a significant gap in knowledge concerning state Medicaid and CHIP oral health programs, and that no central repository or resource was available to access such information.

Also during 2010, MSDA leadership met with a variety of other national stakeholders such as staff from the American Dental Association; Association of State and Territorial Dental Directors; American Academy of Pediatric Dentistry; Association of Maternal and CHIP Health Programs; Centers for Disease Control and Prevention; DentaQuest Institute; DentaQuest Foundation; and others to discuss potential collaborative efforts. During these meetings, all agreed that an exclusive database of Medicaid and CHIP oral health programs would significantly add to and improve the Medicaid information and data available on the Synopsis of State Oral Health Programs (public Health); and enhance information available within the National Oral Health Surveillance System.

In 2010 MSDA received funding from the HRSA, MCHB and the DQF to support the design and early developmental stages of the MSDA Medicaid and CHIP Oral Health Program Survey Questionnaire. MSDA convened a group of national experts to discuss and identify areas of interest for a national Medicaid and CHIP profile, and more specifically, language specificity for the survey questionnaire. Following this meeting, MSDA staff drafted the survey questionnaire, disseminated it to MSDA state members, and an array of external stakeholders for review and comment. In the spring of 2012 the MSDA Board of Directors approved the final draft. In early June the first annual MSDA Medicaid and CHIP Oral Health Program Survey Questionnaire was launched.

Since this time, MSDA has received funding support from the DQF to maintain the National Profile. In 2018, MSDA collaborated with both the DentalQuest Foundation and Institute, now the DentaQuest Partnership, to advance the MSDA National Profile to include CMS-416 Reports. These reports will be available on the MSDA National Profile website beginning in April 2019. By including quantitative national and state level data into the MSDA National Profile, we propose that end users will be able to layer both qualitative and quantitative state level data to better identify best practices.

Methodology:

The Medicaid|Medicare|CHIP Services Dental Association undertakes a multi-step process annually to collect state program information and data, via the MSDA Medicaid and CHIP Oral Health Program Survey Questionnaire, and publish the MSDA National Profile of State Medicaid and CHIP Oral Health Programs. This process includes: design/re-design, development, training; implementation; and evaluation of both the survey questionnaire and the national profile.


Design/Re-design and Development:

As mentioned above, MSDA utilizes a cross-sectional study design by identifying the dates and parameters for the requested program information. Based on the initial recommendation of external advisors to this effort, calendar year rather than program year dates are set as the point in time parameters for the information and data collection periods. MSDA uses the Survey Monkey© platform to collect data from the states. During the annual design/redesign period, MSDA staff updates the survey questionnaire within Survey Monkey© to incorporate the new date parameters and any other changes to the current year survey.


Training:

Each year MSDA staff conducts survey response training via a web-based platform for all state Medicaid and CHIP Oral Health Program administrators. The purpose of the training is to provide technical assistance in survey response via Survey Monkey©, assure consistency across reporting, and improve understanding of each question by each respondent. Prior to the training participants receive a copy of the current survey questionnaire to review and prepare. During the training MSDA staff undertake a systematic review of each question on the survey questionnaire, highlighting the purpose; rationale; intent; and the potential responses to each question. State program participants are encouraged to ask questions to gain clarity and understanding.


Implementation—Survey Dissemination:

Once the survey questionnaire is ready to be launched, MSDA staff disseminates an email to all state Medicaid and CHIP Oral Health key personnel program administrators with a link to access the survey questionnaire. MSDA maintains an up-to-date list of all state administrators with the names and contact information of key personnel responsible for program oversight. State respondents are given directions and a deadline for returning completed surveys. At least two reminder messages are sent and personal phone calls are made to non-responding States as the deadline approaches.


Implementation—Survey Response and Data Collection:

State Medicaid and CHIP program administrators responding to the MSDA survey questionnaire access the survey via an online platform, where survey questions are listed and responses are gathered. 

Validity and Reliability:

In an effort to assure validity and reliability, one examiner systematically reviews all responses and conducts one-on-one phone calls with each state program respondent. During the calls, the examiner systematically reviews each question and response with the respondent to confirm the response accurately meets the intent of the question. This design was established to prevent confounding across multiple examiners; assure accurate interpretation by responders; eliminate duplication with more than one program staff reporting; and confirm that responses are consistent across the states. Following the calls, MSDA staff draft a final report for each state; and return it to the state for their final approval for posting.

Data collection takes approximately five (5) months to complete. The survey is generally launched in June and is completed by November. 


Data Analysis and Preparation for Publication:

Beginning in early November, state program responses are collected by MSDA staff. The information and data are analyzed. MSDA contracts with ThinkBean, a technology firm, to assist in analyzing the data and preparing it for online publication. Each file is scrubbed for misspellings, inconsistencies, gaps, and other notable errors; and corrections are made. Further consultation and confirmation with state program administrators takes place when warranted.

The survey questions are grouped into the following categories for presentation within the National Profile: GENERAL; BENEFITS; POLICY; ADMINISTRATION; and MANAGEMENT.

MSDA staff work with ThinkBean to design the storyboards and develop the web-based specifications for online platform development.  This vendor develops the online site and assists in maintaining it for MSDA. The updated annual online MSDA National Profile is generally available in early spring.


Input and Evaluation:

MSDA holds focus groups each year to gain input from stakeholders on improvements that may be made to the MSDA Survey Questionnaire and MSDA National Profile. Questions are updated annually based on environmental changes in Medicaid and CHIP; and as a result of federal and state legislative and policy changes across the United States.

NOTE: While we understand that multi-year trending in some cases may be difficult to assess due to changes in the MSDA Survey Questionnaire over the years, the end user should note that the  Medicaid environment continues to be in transition; and that MSDA staff have determined the need to prioritize current, valid and relevant state program information over historical.

 


For more information contact:

Ms. Martha Dellapenna
Director, Center for Medicaid and CHIP Oral Health Program Quality, Policy and Financing
mdellapenna@medicaiddental.org