How Medicaid Expansion Has Affected Dentistry


A recent Health Affairs study examined the effect of efforts to enroll more people in dental coverage through Medicaid. Currently under Medicaid, dental coverage for adults is optional. This study examined whether low-income adults with Medicaid dental coverage were more likely to access oral health care than low-income adults without the coverage.

Parents have taken advantage of the Medicaid expansion to provide their children with dental care. But are low-income adults taking advantage of the Medicaid expansion?

Currently, dental coverage under Medicaid is only an optional benefit, but several states and the District of Columbia have expanded eligibility requirements after the passage of the Affordable Care Act (ACA) to allow more people to enroll in the program. A new report in Health Affairs has been published to understand the benefits and impact of a push for greater enrollment in the program.

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For many years, Medicaid has helped families and individuals pay for their health care needs. Many parents take advantage of the program to provide their children with dental benefits, but dental coverage for adults remains an optional benefit.

Previous studies have shown that dental coverage for adults enrolled in Medicaid is a factor in access to and use of dental care among low-income enrollees. In this study, the relationship between yearly dental exams was examined, with researchers attempting to determine if low-income Medicaid enrollees were more likely to use dental care compared to adults with no such benefits. Also, the study looked at the impact of the Medicaid expansion on the use of dental care in both low-income childless adults and parents, specifically in states that do not offer adult dental coverage through the program.

The investigators collected data from 2010-2014 from the Behavioral Risk Factor Surveillance System (BRFSS), a survey that collects self-reported information on preventative health habits and risk factors. In states providing dental benefits to adults through Medicaid, low-income adults did access and receive dental care with greater frequency compared to those without coverage. In fact, enrollees in Medicaid’s dental benefit program had a 9.7 percent greater probability of seeing a dentist compared to residents of states with no such Medicaid benefit.

Childless adults who received dental coverage had a significantly higher probability of dental visits during the study time frame — in 2010, the probability of such adults seeing a dental practitioner was 48.6 percent, while in 2014 the probability had risen to 50.4 percent.

However, in states providing dental benefits through an expanded Medicaid program, enrollees had a decline in the likelihood of seeing a dentist — in 2010, that probability was 52.3 percent, while in 2014 it was only 50.4 percent. In states that expanded their Medicaid programs, the probability of low-income parents seeing a dentist also declined, from 56 percent in 2010 to only 47.9 percent in 2014.

While childless low-income adults might have access to more funding to provide for their own dental health, low-income parents were the driving force behind the decline in dental visits among adults during the study period. The investigators also postulated that the decrease in visits was related to other factors, including dental provider shortages and fewer dentists participating in their states’ Medicaid reimbursement program.

Ultimately, the study concluded with emphasis on the positive impact Medicaid has had on low-income patients, noting that program expansion efforts have increased the use of dental services. However, dental benefits are still optional under the current program, and with the current political climate, it is unknown what any ACA replacement plan would look like, or how they would affect patients nationwide.

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