Logo image
Back
Dental care access for Medicaid beneficiaries: dentist Medicaid participation and dental coverage policy impacts on emergency department use for dental care
Dissertation

Dental care access for Medicaid beneficiaries: dentist Medicaid participation and dental coverage policy impacts on emergency department use for dental care

Pamela Nwachukwu
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Autumn 2025
DOI: 10.25820/etd.008247
pdf
Dissertation_Final15.52 MB
Embargoed Access, Embargo ends: 01/23/2028

Abstract

In the United States, Medicaid provides health insurance coverage for people who have low income and/or are disabled. Many people with Medicaid experience major barriers to accessing needed dental care. Some of the most common barriers include difficulty finding a dental provider who accepts Medicaid and insufficient dental coverage. For people with Medicaid, these access barriers and lack of regular dental care can lead to poor oral health, oral and systemic disease, negative psychological and emotional impacts, and productivity losses. Often, access barriers cause Medicaid enrollees to go to the Emergency Department (ED) for dental problems instead of a dental office, resulting in high and unnecessary healthcare costs. The goal of this dissertation was to explore two key indicators of dental care access for people with Medicaid: dentist Medicaid participation and Emergency Department (ED) use for Non-traumatic Dental Conditions (NTDCs) among Medicaid enrollees. The first access indicator, dentist participation in Medicaid, was explored in relation to Medicaid managed care. Many state Medicaid programs have transitioned to managed care, in part to improve members’ healthcare access and quality. In managed care, states contract with Managed Care Organizations (MCOs) and pay them a set per member per month fee to administer benefits to Medicaid beneficiaries. Dentists are required to be credentialled with MCOs to provide care to Medicaid beneficiaries, and their decisions to participate in Medicaid may be influenced by their experiences with MCOs. Despite many state dental programs using managed care in their dental programs, there is virtually no evidence about how managed care influences dentist participation in Medicaid nor the degree of variation in dentist Medicaid participation across dental MCOs. The first study of this dissertation assessed variation in, and factors associated with, dentist Medicaid participation between the two dental MCOs in the Iowa Medicaid program. Using data from a 2021 survey of Iowa private practice dentists, findings revealed considerable variation in dentist participation between the MCOs, and in the factors associated with dentist participation with each MCO. For both adults and children, participation was four times higher with one MCO than the other. Additionally, for both MCOs, children with Medicaid were almost twice as likely to be accepted by dentists, compared to adults. Varying MCO participation can limit the availability of Medicaid dental providers and in turn, dental care access for Medicaid enrollees. The second access indicator, ED visits for dental care, was studied in relation to dental coverage generosity. State Medicaid programs are not required to provide dental coverage for adults. As a result, there is wide variation in the scope of dental coverage by state and over time. Enrollees in states with less generous dental benefits are less likely to visit a dental office for care, and more likely to present to the ED for preventable NTDCs. Most EDs are not equipped to provide dental care, resulting in expensive ED visits that do not address the source of dental problems. Every year, dental ED visits cost an estimated $1.7 to $2.4 billion in healthcare expenditures in the United States. Studies have found that when states reduce or eliminate Medicaid adult dental benefits, ED visits for dental care increase. Few studies have explored the impact of expanding dental benefits on ED use, and no study had assessed the impact of introducing emergency dental benefits from previously having no benefits. Several states have adopted this approach in an attempt to expand dental benefits and reduce dental ED use while also keeping costs low. The second and third studies of this dissertation assessed the impact of a policy change in the state of Arizona whereby emergency-only adult dental benefits were introduced, from previously having no dental coverage. Using data from the State Emergency Department Database (SEDD) and two different quasi-experimental study designs, the impact of this benefit introduction on ED use for NTDCs among adults with Medicaid was explored. Findings revealed that ED use did not change due to this new benefit. However, in subgroup analyses, people who are Hispanic and those with very low income had significant reductions in NTDC ED use immediately after the new dental benefits were introduced. It is critically important that policymakers consider evidence in making decisions that impact dental care access for Medicaid beneficiaries. State Medicaid programs should consider strategies to encourage dentist Medicaid participation with MCOs to improve Medicaid provider availability and dental care access. State Medicaid policymakers should also consider provision of more comprehensive adult dental benefits to meet the dental needs of adults with Medicaid.
 Dental Care Access Dental Care Utilization Dental Public Health Health Services Research Medicaid Oral Health Disparities

Details

Metrics

1 Record Views
Logo image