title: Medicaid dental coverage alone may not lower rates of dental emergency department visits.
abstract: Medicaid was expanded to millions of individuals under the Affordable Care Act, but many states do not provide dental coverage for adults under their Medicaid programs. In the absence of dental coverage, patients may resort to costly emergency department (ED) visits for dental conditions. Medicaid coverage of dental benefits could help ease the burden on the ED, but ED use for dental conditions might remain a problem in areas with a scarcity of dentists. We examined county-level rates of ED visits for nontraumatic dental conditions in twenty-nine states in 2010 in relation to dental provider density and Medicaid coverage of nonemergency dental services. Higher density of dental providers was associated with lower rates of dental ED visits by patients with Medicaid in rural counties but not in urban counties, where most dental ED visits occurred. County-level Medicaid-funded dental ED visit rates were lower in states where Medicaid covered nonemergency dental services than in other states, although this difference was not significant after other factors were adjusted for. Providing dental coverage alone might not reduce Medicaid-funded dental ED visits if patients do not have access to dental providers.
authors.affiliation: Kathryn R. Fingar (katie.fingar@truvenhealth.com) is a research leader at Truven Health Analytics in Sacramento, California.
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Fingar
authors.affiliation: Mark W. Smith is a director in the Federal Government Division of Truven Health Analytics in Bethesda, Maryland.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Smith
authors.affiliation: Sheryl Davies is a research associate in the Center for Health Policy and the Center for Primary Care and Outcomes Research at Stanford University, in California.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Davies
authors.affiliation: Kathryn M. McDonald is executive director of and a senior scholar at the Center for Health Policy and the Center for Primary Care and Outcomes Research at Stanford University.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: McDonald
authors.affiliation: Carol Stocks is a senior research analyst in the Center for Delivery, Organization, and Markets at the Agency for Healthcare Research and Quality, in Rockville, Maryland.
authors.forename: Carol
authors.initials: C
authors.lastname: Stocks
authors.affiliation: Maria C. Raven is an associate professor of emergency medicine at the University of California, San Francisco.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Raven
mesh_terms: D003752:Dental Health Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007347:Insurance, Dental; D008484:Medicaid; D014481:United States
keywords: Medicaid; dental health; dental insurance; dental providers; emergency department utilization