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National Disparities In Medicaid Access To Orthotic Helmet Therapy For Deformational Plagiocephaly
Aaron Long, B.S., Sacha Hauc, M.P.H., Alicia Stephan, B.S., Adam Junn, B.S., Jean Carlo Rivera, B.S., Jacob Dinis, B.S., Alexandra Junn, A.B., John Persing, M.D., Michael Alperovich, M.D., M.Sc..
Yale School of Medicine, New Haven, CT, USA.

Purpose: Cranial orthosis, or helmet therapy, is used for the treatment of deformational plagiocephaly (DP). Factors affecting outcomes of therapy have been examined, but the role of insurance provider is understudied. We analyzed referrals to a national helmet manufacturer to evaluate the impact of insurance status on access to helmet therapy.
Methods: Of 211,417 referrals to Cranial Technologies in 2014-2020 in 21 US States, 141,513 received treatment. Multivariate analysis was used to identify relationships between payer-status and likelihood of receiving a helmet and experiencing delayed presentation or treatment.
Results: Patients with Medicaid were less likely to receive treatment (OR: 0.626, p<0.0001) and more likely to present late (OR: 1.550, p<0.0001) compared to the commercially insured. Patients with Medicaid were less likely to receive a helmet in 9 states, with the strongest association in Texas (OR: 0.315, p<0.0001), and more likely to receive a helmet in 5 states, with the strongest association in Colorado (OR: 1.886, p=0.0002). Medicaid was associated with delayed treatment in all states.
Conclusions: Patients with Medicaid presented later and were less likely to receive a helmet compared to commercially insured patients. Access to treatment reflected state Medicaid policies. Texas Medicaid declines to cover helmets general, while Colorado considers helmets a covered benefit. Patients with Medicaid were twice as likely in Colorado and a third as likely in Texas to receive helmet therapy. Similar results were observed in other States based on restrictiveness of Medicaid requirements. Restrictive Medicaid policies in some States likely limit access to helmet therapy.


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