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Study: Results of Medicaid expansion on adult dental services mixed

April 17, 2017

By Michelle Manchir

Low-income adults use more dental care when it is covered under Medicaid. However, an analysis published in April in Health Affairs showed mixed results when it came to dental services used under Medicaid expansion associated with the Affordable Care Act.

Researchers found that low-income adults in states that provided dental benefits beyond emergency-only coverage were more likely to have had a dental visit in the past year compared to low-income adults in states without such benefits.

Among states that provided dental benefits and expanded their Medicaid program under the Affordable Care Act, researchers said regression-based estimates indicate that childless adults had a significant increase in the likelihood of having a dental visit, while low-income parents had a significant decline.

"While we did not examine supply-side issues in dental care, our results suggest that there appears to be some rate-limiting factor in terms of dental visits for low-income adults in these states," said the article's lead author, Dr. Astha Singhal. "We think that after expansion, several low-income childless adults gained Medicaid dental coverage, who likely did not have prior dental coverage and hence, may have pent-up dental needs. While [the ACA] expanded coverage, the dental provider capacity essentially remained unchanged. So now the newly covered childless adults with dental needs might be competing with previously enrolled low-income parents for the limited appointments with dental providers who see Medicaid patients."

For the article, "Medicaid Adult Dental Benefits Increase Use of Dental Care, But Impact of Expansion On Dental Services Was Mixed," researchers analyzed data from the Behavioral Risk Factor Surveillance System, state Medicaid websites and other reports to examine changes in dental visits from 2010 to 2014 by state expansion and dental benefit status.

Researchers said their findings suggest that expansions in coverage need to be complemented with additional policy interventions that increase the capacity of dental providers willing to treat Medicaid enrollees, including evaluation of alternative dental provider models and increasing Medicaid reimbursement rates for dental procedures.

Relatedly, in 2016, the American Dental Association Health Policy Institute released an article published in Health Services Research that examined the impact of the Affordable Care Act on dental care use among poor adults in 2014. It found that dental care use increased between 2 and 6 percent points in Medicaid expansion states with adult dental benefits relative to the pre-health care reform period and other states, but that most of the changes were not statistically significant.

"Early evidence suggests that the Affordable Care Act may either not be having a substantial impact on dental care use or it is too early to assess the impact," the research brief concluded.