Changes in Dental Benefits and Use of Emergency Departments for Nontraumatic Dental Conditions in Massachusetts

Abstract

Objectives Research examining the effect of changes in Medicaid dental benefits on emergency department (ED) use for dental conditions has had mixed results. We examined the effect of changes in Medicaid dental benefits on ED use for nontraumatic dental conditions (NTDCs) among adults in Massachusetts before and after Medicaid dental benefits for adults were eliminated (July 2010) and partially restored (January 2013). Methods We used 2009-2013 data from the Massachusetts All-Payer Claims Database. The study population included Medicaid enrollees aged ≥21 who made a visit to the ED for an NTDC that was paid for by Medicaid during the study period. We used an interrupted time-series study design and segmented regression model to assess the effect of the policy changes on ED use for NTDCs. We also conducted a subanalysis by patient age, sex, and geographic location. Results During the study period, 21 731 Medicaid enrollees aged ≥21 made 35 660 NTDC ED visits. Eliminating comprehensive dental benefits led to a significant increase in the use of EDs for NTDCs. This increase occurred over time (11% increase at 15 months after elimination of comprehensive dental benefits; estimate, 0.64 [95% CI, 0.07-1.21]; P = .03) rather than immediately after the policy change took effect. The partial restoration of certain dental benefits led to a significant decrease in the rate of ED visits for NTDCs over time (15.7% decrease at 5 months after partial restoration of certain dental benefits; estimate, –0.97 [95% CI, –1.83 to –0.11]; P = .03). Conclusion Strengthening dental coverage policies for adult Medicaid enrollees could decrease their reliance on EDs for NTDCs.

Synthesizing 30-years of adult medicaid dental policy research: A scoping review to identify gaps and opportunities

“…Each of the 53 studies met the inclusion criteria for evaluating an Adult Medicaid dental policy between 1991 and 2020 [ [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] ]. Supplemental Table 1 provides a tabulated overview for all 53 studies.…”

“…Reducing, but not eliminating Medicaid dental benefits was consistently found to increase non-traumatic dental services in emergency departments or hospitals [ 35 , 52 , 55 ]. Benefit reductions were also found to increase unmet dental needs [ 67 ].…”

Effects of Adult Medicaid Dental Benefits Elimination on Child Dental Care Use

“…Although adult dental benefits are typically eliminated to reduce state spending, adult Medicaid enrollees may seek care through costlier venues after losing benefits. Studies from California and Massachusetts reported that when Medicaid adult dental benefits were eliminated, emergency department visits for nontraumatic dental conditions among adults significantly increased along with associated costs 13,14. Fewer studies have examined the indirect effects of Medicaid adult dental benefit elimination on child dental care use.…”

“…Studies from California and Massachusetts reported that when Medicaid adult dental benefits were eliminated, emergency department visits for nontraumatic dental conditions among adults significantly increased along with associated costs. 13,14 Fewer studies have examined the indirect effects of Medicaid adult dental benefit elimination on child dental care use. Studies have found associations between parent dental benefits, parent dental care use and child dental care use.…”