Three essays evaluating how policies expanding access to Medicaid dental services impact early detection of oral cancer in low-income adults

Every year in America, over 10,000 adults die from oral cancer. This disease primarily affects lower income adults. While there are differences by socioeconomic and Human Papillomavirus (HPV) status, the stage at diagnosis is an important factor for patient outcomes. Earlier detection of oral cancer is associated with longer survival, lower treatment costs, and better quality of life. Unfortunately, less than 30% of oral cancers are detected early and evidence for improving early detection has been limited. The first study analyzes nationally representative oral cancer screening data to determine if the ACA increased oral cancer screening rates for physicians or dentists. Before and after the ACA, low-income adults had the lowest prevalence of oral cancer screenings. However, the ACA was associated with higher oral cancer screenings for low-income adults, but only for screenings performed by dentists. The second study reexamines the effect of Medicaid expansion on early detection of oral cancer in states offering Medicaid dental benefits. We found that expanding Medicaid eligibility was associated with a decrease in late-stage diagnoses, but only for HPV(-) oral cancers in states which added Medicaid dental benefits. The third study evaluated California’s decision to drop Medicaid dental benefits. Among Medicaid patients diagnosed with non-oropharyngeal HPV(-) oral cancer, dropping Medicaid dental benefits was associated with a decline in early-stage diagnoses. This effect was highest in counties with more available dentists. Unequal access to Medicaid dental coverage and provider shortages delays oral cancer detection. Alternative approaches are needed to promote early detection of HPV+ oral cancer.