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ADA Health Policy Institute

Dental Benefits and Medicaid

Did my state expand Medicaid eligibility, and what does that mean for my dental practice?

As of March 2015, 29 states including the District of Columbia expanded Medicaid eligibility for adults. Increased demand for Medicaid dental services among children and adults is likely to increase moving forward, regardless of Medicaid expansion. The growth in demand depends on the level of adult dental benefits covered by each state, and the number of uninsured individuals that qualify for Medicaid moving forward.

Source: Yarbrough C, Vujicic M, Nasseh K. Medicaid market for dental care poised for major growth in many states. Health Policy Institute Research Brief. American Dental Association. December 2014. Available from: http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1214_3.ashx.

Related Item: The Henry J. Kaiser Family Foundation. Status of State Action on the Medicaid Expansion Decision. State Health Facts. As of March 6, 2015. Available from: http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/.

 

What share of US children and adults have dental benefits?

Dental benefits coverage varies by age. For children ages 2-18, 49.7 percent have private dental benefits, 37.2 percent of dental benefits through Medicaid or the Children’s Health Insurance Program (CHIP), and 13.1 percent do not have dental benefits. For adults ages 19-64, 55.9 percent have private dental benefits, 10.1 percent have dental benefits through Medicaid, and 34.0 percent do not have dental benefits. For adults ages 65 and older, 25.9 percent have private dental benefits, 10.2 percent have dental benefits through Medicaid, and 63.9 percent do not have dental benefits.

Source: Nasseh K, Vujicic M. Dental benefits expanded for children, young adults in 2012. Health Policy Institute Research Brief. American Dental Association. October 2014. Available from: http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1014_5.ashx.

 

Does my state cover dental services for adult Medicaid enrollees?

Adult dental benefits are an optional benefit under Medicaid. As of January 2015, 32 Medicaid programs cover adult dental services beyond emergency services. However, in some states adults dental services are covered through managed care organization, even though the state Medicaid program does not traditionally provide adult dental benefits. Please refer to the source below to learn more about the adult dental benefits available in your state.

Source: Yarbrough C, Vujicic M, Nasseh K. Medicaid market for dental care poised for major growth in many states. Health Policy Institute Research Brief. American Dental Association. December 2014. Available from: http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1214_3.ashx.

 

How does dental care utilization among Medicaid enrollees compare to dental care utilization among commercially-insured individuals?

In general, dental care utilization is higher among individuals with private dental benefits compared to individuals with Medicaid dental benefits. However, dental utilization among Medicaid-enrolled children has been increasing over the past decade.

Source: Nasseh K, Vujicic M. Dental care utilization rate highest ever among children, continues to decline among working-age adults. Health Policy Institute Research Brief. American Dental Association. October 2014. Available from: http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1014_4.ashx.

Related Item: State-level Medicaid-enrolled child dental care utilization rates can be obtained from the Centers for Medicare & Medicaid Services. Please see http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-and-Periodic-Screening-Diagnostic-and-Treatment.html.