Eliminating Medicaid adult dental coverage in California led to increased dental emergency visits and associated costs.
Dental coverage for adults is an elective benefit under Medicaid. As a result of budget constraints, California Medicaid eliminated its comprehensive adult dental coverage in July 2009. We examined the impact of this policy change on emergency department (ED) visits by Medicaid-enrolled adults for dental problems in the period 2006-11. We found that the policy change led to a significant and immediate increase in dental ED use, amounting to more than 1,800 additional dental ED visits per year. Young adults, members of racial/ethnic minority groups, and urban residents were disproportionately affected by the policy change. Average yearly costs associated with dental ED visits increased by 68 percent. The California experience provides evidence that eliminating Medicaid adult dental benefits shifts dental care to costly EDs that do not provide definitive dental care. The population affected by the Medicaid adult dental coverage policy is increasing as many states expand their Medicaid programs under the ACA. Hence, such evidence is critical to inform decisions regarding adult dental coverage for existing Medicaid enrollees and expansion populations.
Astha Singhal (asthasinghal@gmail.com) is a PhD candidate in the Department of Preventive and Community Dentistry, College of Dentistry, and a research assistant at the Public Policy Center, both at the University of Iowa, in Iowa City.
Astha
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Singhal
Daniel J. Caplan is a professor and department executive officer in the Department of Preventive and Community Dentistry, College of Dentistry, at the University of Iowa.
Daniel J
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Caplan
Michael P. Jones is a professor in the Department of Biostatistics, College of Public Health, at the University of Iowa.
Michael P
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Jones
Elizabeth T. Momany is an associate research scientist at the Public Policy Center, University of Iowa.
Elizabeth T
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Momany
Raymond A. Kuthy is a professor in the Department of Preventive and Community Dentistry, College of Dentistry, at the University of Iowa.
Raymond A
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Kuthy
Christopher T. Buresh is an associate professor in the Department of Emergency Medicine, College of Medicine, at the University of Iowa.
Christopher T
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Buresh
Robert Isman is a dental program consultant in the Medi-Cal Dental Services Division of the California Department of Health Care Services, in Sacramento.
Robert
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Isman
Peter C. Damiano is a professor in the Department of Preventive and Community Dentistry, College of Dentistry, and director of the Public Policy Center, both at the University of Iowa.
Peter C
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Damiano
D000328:Adult; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics* / Q000706:statistics & numerical data*; D007347:Insurance, Dental / Q000191:economics* / Q000706:statistics & numerical data*; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data*; D000069342:Medical Overuse / Q000191:economics* / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000706:statistics & numerical data; D014481:United States
Dental Diseases; Emergency Department; Medicaid Policy; Oral Health Care; State/Local Issues