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Case study: Expanding Medicaid coverage to include dental benefits improves patient outcomes

University of Colorado School of Dental Medicine, CareQuest Institute for Oral Health look at Colorado’s positive experience

September 30, 2021

By David Burger

Colorado case study cover

Boulder, Colo.
— Expanding Medicaid coverage to include dental benefits has ultimately improved patient outcomes in Colorado, according to a new case study authored by the University of Colorado School of Dental Medicine and the CareQuest Institute for Oral Health.

The study, “Expanding Dental Benefits Is Good for States. Just Ask Colorado,” arrives as the infrastructure bill is making its way through Congress, putting a renewed focus on expanding adult dental benefits under Medicaid.
 
The lead author, Tamanna Tiwari, M.D.S., B.D.S., assistant professor in the Department of Community Dentistry and Population Health at the University of Colorado School of Dental Medicine, and Julie Frantsve-Hawley, Ph.D., director, Analytics and Evaluation for the CareQuest Institute for Oral Health, stressed the importance of expanding public programs, such as Medicaid, based on Colorado’s experience.

A comprehensive Medicaid dental benefit offers the opportunity for low-income adults to retain their teeth and have an overall better quality of life, said Dr. Tiwari.

“The remaining states who currently choose not to offer dental benefits for adults should look to the initial successes in Colorado,” she said.

Colorado was one of the states that chose to expand Medicaid adult dental benefits under the Affordable Care Act, Dr. Frantsve-Hawley said. As of 2014, adult Medicaid-eligible members could receive up to $1,000 annually toward the cost of dental services, and in 2019, the cap was raised to $1,500. The benefit covers procedures such as dental exams, crowns, partial dentures and root canals.

“Unfortunately, there are states, like Alabama or Tennessee, that do not have any Medicaid adult dental benefits,” Dr. Frantsve-Hawley said.

The case study describes the impact of Medicaid expansion in Colorado, focused on key findings from the experiences of the University of Colorado School of Dental Medicine:
• After expansion, the total number of adult Medicaid patients seen at the dental school increased by almost 350%.
• The clinic saw a 51% increase in tooth-saving procedures (e.g., restoration, endodontic and periodontal treatments) and a 22% decrease in extractions.
• Tooth-saving procedures increased in all ethnicities and all ages above 21 years.

The researchers not only studied the improved health of low-income patients, but also the benefits that providers could reap from expanded Medicaid coverage.

The study’s authors wrote, “Although the Medicaid reimbursement rates are lower, adding the benefits enabled additional preventive and restorative care for their patients, which not only helped increase revenue, but led to higher satisfaction for the team as they were able to improve quality of life for their patients. One of the aspects that the dentists discussed from a business perspective was that adding the adult Medicaid benefit would likely increase the number of patients seen in their practice.”

In a show of support, Colorado dentists have taken measures to preserve the adult dental Medicaid benefit.

During the pandemic, the Colorado joint budget committee proposed several budget cuts, and one of the options was the elimination of the adult dental Medicaid benefit. The Colorado Dental Association and several dentists came together to save the Medicaid adult dental benefit.

“In Colorado, the dental community has embraced the adult Medicaid benefit, which has improved the oral health of those who often lack adequate access to care,” said Dr. Frantsve-Hawley.

“The expense of strengthening Medicaid to include dental care has been widely debated, with people disputing whether or not the cost outweighs the benefits,” Dr. Tiwari said. “But the initial impact we have seen in Colorado is a testament that the Medicaid adult benefit has the capacity to improve oral health outcomes, which is something every state should be aiming for.”