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

Semprini, Jason; Samuelson, Riley J.

doi:10.1016/j.heliyon.2023.e13703

Cited by 5 publications

(8 citation statements)

References 62 publications

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“…Dental insurance was not a contributor to heterogenous declines in dental utilization from the pandemic. However, our results reiterated the importance of dental insurance as a contributor to visiting the dentist [ 29 , 30 ]. Adults with dental coverage were over 10%-points more likely to visit the dentist in the past year compared to adults without coverage, in 2019 and 2020.…”

Section: Discussionsupporting

confidence: 73%

“…Adults with dental coverage were over 10%-points more likely to visit the dentist in the past year compared to adults without coverage, in 2019 and 2020. Continued expansion of affordable dental coverage, whether through Medicaid Expansion paired with Medicaid dental coverage, subsidized dental insurance markets, or adults Medicare dental coverage should be explored for their potential efficacy in reducing dental care delays in 2021 and beyond [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

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Estimating the Within-Person Change in Dental Service Access Measures during the COVID-19 Pandemic in the United States

Semprini

2023

International Journal of Dentistry

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Background. American adults delay dental care more than any other healthcare service. Unfortunately, the COVID-19 pandemic may have stalled efforts to address dental service delays. Early evidence has suggested substantial declines in dental service visits in the early phase of the pandemic; however, our study is among the first to measure within-person changes from 2019 to 2020 and conduct subgroup analyses to examine if changing dental patterns were mediated by exposure to the pandemic, risk of adverse COVID-19 outcomes, or dental insurance. Methods. We analyzed a National Health Interview Survey panel of individuals initially surveyed in 2019, with subsequent follow-up in 2020. The outcomes included dental service access measures and the interval of a most recent dental visit. By constructing a probability-weighted linear regression model with fixed-effects, we estimated the average within-person change from 2019 to 2020. Robust standard errors were clustered within each respondent. Results. From 2019 to 2020, adults reported a 4.6%-point reduction in the probability of visiting the dentist ( p < 0.001 ). Significantly higher declines were found in Northeast and West regions compared to Midwest and South regions. We find no evidence that declining dental services in 2020 were associated with more chronic diseases, older age, or lack of dental insurance coverage. Adults did not report more financial or nonfinancial access barriers to dental care in 2020 compared to 2019. Conclusions. The long-term effects of the COVID-19 pandemic on delayed dental care warrant continued monitoring as policymakers aim to mitigate the pandemic’s negative consequences on oral health equity.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Estimating the Within-Person Change in Dental Service Access Measures during the COVID-19 Pandemic in the United States

Semprini

2023

International Journal of Dentistry

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“…Most states today operate their Medicaid dental program via a managed care system, each implementing different strategies to control oral health care and expenditures 47 . There is a well‐established, causal relationship between access to generous Medicaid dental benefits and higher utilization of dental services 48,49 . Undoubtedly, by preventing low‐income adults from accessing affordable health insurance, the persistence of non‐expansion states likely contributes to health inequities 50 .…”

Section: Discussionmentioning

confidence: 99%

Examining the effect of Medicaid expansion on early detection of head and neck cancer of the oral cavity and pharynx by HPV‐type and generosity of dental benefits

Semprini

2023

Cancer Reports

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BackgroundOver a decade of evidence supports the claim that increased access to insurance through Medicaid expansions improves early detection of cancer. Yet, evidence linking Medicaid expansions to early detection of head and neck cancers (HNC) of the oral cavity and pharynx, specifically, may be limited by the lack of attention to Human Papillomavirus (HPV) etiology, generosity of dental coverage, and valid inference analyzing state cancer registry data.AimsThis study reexamined the effect of Medicaid expansion on early detection of HPV+/− HNC in states offering extensive dental benefits.Materials and MethodsSpecialized data from the Surveillance, Epidemiology, and End Results (SEER) program was analyzed to account for, previously unmeasurable, differential detection patterns of HNCs associated with HPV. Then, to identify the effect of increasing Medicaid eligibility on staging patterns in states offering extensive benefits amidst potentially non‐common trends between states, a “Triple Differences” design identifies the differential effect of Medicaid Expansion (with dental coverage) on HPV‐negative HNCs relative to the change in HPV‐positive HNCs. For valid inference analyzing a small number of state clusters (12) in cancer registry data, each regression model applies a Wild Cluster Bootstrap.ResultsExpanding Medicaid eligibility was found to be associated with a decrease in the proportion of distant‐stage diagnoses of HPV(−) HNCs, but only among states which increased Medicaid dental generosity at the time of Medicaid expansion.ConclusionsThese results suggest that adding extensive Medicaid dental benefits was the primary mechanism impacting HNC detection. This study highlights the potential positive spillover effects of policies which increase access to public dental coverage for low‐income adults, while also showing the limitation of access to dental services for improving early detection of HPV+ HNCs.

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“…Medicaid dental coverage and benefits impact Medicaid dental care. 28 Among the services most responsive to changing dental benefits are comprehensive exams: the service where most oral cancer screenings are performed. 5,29 By hindering access to comprehensive exams, dropping Medicaid dental benefits may have slowed the detection of oral cancer among low-income adults.…”

Section: Medicaid Dental Benefits and Oral Cancer Detectionmentioning

confidence: 99%

“…The potential consequences of dropping Medicaid dental coverage for low‐income adults at risk of developing oral cancer could be dire. Medicaid dental coverage and benefits impact Medicaid dental care 28 . Among the services most responsive to changing dental benefits are comprehensive exams: the service where most oral cancer screenings are performed 5,29 .…”

Section: Introductionmentioning

confidence: 99%

Eliminating Medicaid dental benefits and early‐stage oral cancer diagnoses

Semprini,

Reynolds,

Zahnd

et al. 2024

Cancer Medicine

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BackgroundDespite the importance of regular dental visits for detecting oral cancer, millions of low‐income adults lack access to dental services. In July 2009, California eliminated adult Medicaid dental benefits. We tested if this impacted oral cancer detection for Medicaid enrollees.MethodsWe analyzed Surveillance, Epidemiology, and End Results‐Medicaid data, which contains verified Medicaid enrollment status, to estimate a difference‐in‐differences model. Our design compares the change in early‐stage (Stages 0–II) diagnoses before and after dropping dental benefits in California with the change in early‐stage diagnoses among eight states that did not change Medicaid dental benefits. Patients were grouped by oropharyngeal cancer (OPC) and non‐OPC (oral cavity cancer), type, and the length of Medicaid enrollment. We also assessed if the effect of dropping dental benefits varied by the number of dentists per capita.ResultsDropping Medicaid dental benefits was associated with a 6.5%‐point decline in early‐stage diagnoses of non‐OPC (95% CI = −14.5, −3.2, p = 0.008). This represented a 20% relative reduction from baseline rates. The effect was highest among beneficiaries with 3 months of continuous Medicaid enrollment prior to diagnosis who resided in counties with more dentists per capita. Specifically, dropping dental coverage was associated with a 1.25%‐point decline in the probability of early‐stage non‐OPC diagnoses for every additional dentist per 5000 population (p = 0.006).ConclusionsEliminating Medicaid dental benefits negatively impacted early detection of cancers of the oral cavity. Continued volatility of Medicaid dental coverage and provider shortages may be further delaying oral cancer diagnoses. Alternative approaches are needed to prevent advanced stage OPC.

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

Cited by 5 publications

References 62 publications

Estimating the Within-Person Change in Dental Service Access Measures during the COVID-19 Pandemic in the United States

Estimating the Within-Person Change in Dental Service Access Measures during the COVID-19 Pandemic in the United States

Examining the effect of Medicaid expansion on early detection of head and neck cancer of the oral cavity and pharynx by HPV‐type and generosity of dental benefits

Eliminating Medicaid dental benefits and early‐stage oral cancer diagnoses

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