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. 2020 Jun;55(3):367-374.
doi: 10.1111/1475-6773.13261. Epub 2020 Jan 15.

Changes in emergency department dental visits after Medicaid expansion

Hawazin W Elani  1 , Ichiro Kawachi  2 , Benjamin D Sommers  3
Affiliations

Changes in emergency department dental visits after Medicaid expansion

Hawazin W Elani et al. Health Serv Res. 2020 Jun.

Abstract

Objectives: To estimate the effect of Medicaid expansion under the Affordable Care Act (ACA) on the frequency and payment source for Emergency Department (ED) visits for dental care.

Study design: Retrospective, quasi-experimental study.

Data sources/study setting: We used the State Emergency Department Database to compare changes in ED visit rates and payment source for dental conditions among patients from 33 states. These states represent four distinct policy environments, based on whether they expanded Medicaid and whether their Medicaid programs provide dental benefits. We first assessed the number of ED dental visits before (2012) and after (2014) the ACA. Then, we used differences-in-differences regression to estimate changes in insurance for dental visits by nonelderly adults.

Principal findings: Our sample contained 375 944 dental ED visits. In states that expanded Medicaid and offered dental coverage, dental ED visits decreased by 14.1 percent (from 19 443 to 16 709, for a net difference of 2734). By contrast, in the remaining three state groups, dental ED visits rose. Meanwhile, the expansion significantly increased Medicaid coverage and decreased the rate of self-pay for ED dental visits.

Conclusions: Medicaid expansion, combined with adult dental coverage in Medicaid, was associated with a reduction in ED utilization for dental visits.

Keywords: dentistry/dental care; emergency service; health policy/politics/law/regulation; hospital; medicaid; observational data/quasi-experiments.

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Conflict of interest statement

The authors declare no competing interest.

Figures

Figure 1
Figure 1
Changes in emergency department dental visits counts by health insurance status [Color figure can be viewed at wileyonlinelibrary.com] Note. Study sample limited to adults aged 19‐64 yrs with income within the first income quartile calculated for median household income for patient’s ZIP code. Medicaid expansion states: AR, AZ, CT, DC, IA, KY, MD, MA, MI, MN, NV, NJ, NM, NY, OH, OR, WV. Nonexpansion states: AL, FL, GA, IN, LA, MS, MO, NE, NC, OK, PA, TN, TX, UT, VA, WI. States that provide adult Medicaid dental benefits: AR, CT, DC, IN, IA, KY, MA, MI, MN, NE, NJ, NM, NY, NC, OH, OR, PA, WI. States without adult Medicaid dental benefits: AL, AZ, FL, GA, LA, MD, MS, MO, NV, OK, TN, TX, UT, VA, WV
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