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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 January 2017, 32 states including the District of Columbia expanded Medicaid eligibility. Of those states, 23 states including the District of Columbia provide at least limited dental benefits for adults (updated May 2017). 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: The Henry J. Kaiser Family Foundation. Status of State Action on the Medicaid Expansion Decision. State Health Facts. As of January 1, 2017. Available from: http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/.

HPI analysis of state Medicaid websites. 

 

What share of U.S. children and adults have dental benefits?

Dental benefits coverage varies by age. For children ages 2-18, 50.3 percent have private dental benefits, 38.7 percent of dental benefits through Medicaid or the Children’s Health Insurance Program (CHIP), and 11.0 percent do not have dental benefits. For adults ages 19-64, 58.1 percent have private dental benefits, 6.7 percent have dental benefits through Medicaid, and 35.2 percent do not have dental benefits. For adults ages 65 and older, 27.9 percent have private dental benefits, 10.1 percent have dental benefits through a public program, and 62.0 percent do not have dental benefits.

Source: Dental Benefits Coverage Increased for Working-Age Adults in 2014 (Health Policy Institute Research Brief).

 

Does my state cover dental services for adult Medicaid enrollees?

Adult dental benefits are an optional benefit under Medicaid. As of August 2017, 30 states including the District of Columbia provide at least limited dental benefits for adults beyond emergency services. However, in some states, adult dental services are covered through managed care organizations, even though the state Medicaid program does not traditionally provide adult dental benefits.  

Source: HPI analysis of state Medicaid websites.

 

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. Data are as of 2014.

Source: Dental Care Utilization Steady Among Working-Age Adults and Children, Up Slightly Among the Elderly (Health Policy Institute Research Brief).

 

How many dentists accept Medicaid?

As of 2015, approximately 38 percent of dentists in the U.S. accept Medicaid or the Children’s Health Insurance Program (CHIP). Medicaid acceptance varies by dentist gender, age, specialty, and the state in which they practice.

Source: Dentist Participation in Medicaid or CHIP (Health Policy Institute Infographic).

 

How many Medicaid patients have access to Medicaid dentists?

The Health Policy Institute has developed a tool for measuring access to dental care using geo-analytics for each state and the District of Columbia. Results report the percentage of publicly insured children living within a 15-minute travel time to at least one Medicaid/CHIP dentist per 2,000 publicly insured children as well as the percentage of overall population living within a 15-minute travel time to at least one dentist per 5,000 population. Data are as of 2015.

Source: Geographic Access to Dental Care (Health Policy Institute State Fact Sheets).