Changes In Coverage And Access To Dental Care Five Years After ACA Medicaid Expansion

Abstract

With the implementation of the Affordable Care Act (ACA), millions of low-income adults gained health coverage. We examined how the ACA's expansion of Medicaid eligibility affected dental coverage and the use of oral health services among low-income adults, using data from the National Health Interview Survey from the period 2010-18. We found that the ACA increased rates of dental coverage by 18.9 percentage points in states that provide dental benefits through Medicaid. In terms of utilization, expansion states that provide dental benefits saw the greatest increase in people having a dental visit in the past year (7.2 percentage points). However, there was no significant change in the overall share of people who had a dental visit in the past year, although the expansion was associated with a significant increase in this metric among White adults. The expansion was also associated with a 1.4-percentage-point increase in complete teeth loss, which may be a marker of both poor oral health and the potential gaining of access to dental services (with subsequent tooth extractions). Our findings suggest that in addition to expanded coverage, policies need to tackle other barriers to accessing dental care to improve population oral health.

Appendix Exhibit A1:

Unadjusted Changes in in Access to Dental Care Outcomes in Expansion and Control States According to State’s Dental Benefits. SOURCE: Authors’ analysis of data from the National Health Interview Survey from 2010 to 2018 excluding 2014. NOTES: Study sample limited to adults aged 19–64 years old with income 124% below the FPL. Medicaid expansion states: AK, AR, AZ, CA, CO, CT, DC, DE, HI, IA, IL, IN, KY, LA, MA, MD, MI, MN, MT, ND, NH, NJ, NM, NV, NY, OH, OR, PA, RI, VT, WA, WV. Medicaid non-expansion states: AL, FL, GA, ID, KS, ME, MO, MS, NC, NE, OK, SC, SD, TN, TX, UT, VA, WI, WY. States that provide adult Medicaid dental benefits: AK, AR, CA, CO, CT, DC, IA, IL, IN, KY, MA, MI, MN, NC, ND, NE, NJ, NM, NY, OH, OR, PA, RI, SC, SD, VT, WA, WI, WY. States without adult Medicaid dental benefits: AL, AZ, DE, FL, GA, HI, ID, KS, LA, MD, ME, MO, MS, MT, NH, NV, OK, TN, TX, UT, VA, WV. ^a Unadjusted survey-weighted proportions.

Appendix Exhibit A3:

Unadjusted Trends in Insurance Coverage and Access to Dental Care Measures According to Medicaid Expansion Status. SOURCE: Authors’ analysis of data from the National Health Interview Survey from 2010-to 2018. NOTES: Medicaid expansion states: AK, AR, AZ, CA, CO, CT, DC, DE, HI, IA, IL, IN, KY, LA, MA, MD, MI, MN, MT, ND, NH, NJ, NM, NV, NY, OH, OR, PA, RI, VT, WA, WV. Medicaid non-expansion states: AL, FL, GA, ID, KS, ME, MO, MS, NC, NE, OK, SC, SD, TN, TX, UT, VA, WI, WY. Study sample limited to adults aged 19–64 years old with income 124% below the FPL. All estimates are unadjusted survey-weighted proportions. Bars represents 95% confidence interval.

Exhibit 2:

Unadjusted Changes in Dental Coverage in Medicaid Expansion and Control States According to State’s Dental Benefits. SOURCE: Authors’ analysis of data from the National Health Interview Survey from 2010-to 2018 excluding 2014. NOTES: Study sample limited to adults aged 19–64 years old with income 124% below the FPL. Medicaid expansion states: AK, AR, AZ, CA, CO, CT, DC, DE, HI, IA, IL, IN, KY, LA, MA, MD, MI, MN, MT, ND, NH, NJ, NM, NV, NY, OH, OR, PA, RI, VT, WA, WV. Medicaid non-expansion states: AL, FL, GA, ID, KS, ME, MO, MS, NC, NE, OK, SC, SD, TN, TX, UT, VA, WI, WY. States that provide adult Medicaid dental benefits: AK, AR, CA, CO, CT, DC, IA, IL, IN, KY, MA, MI, MN, NC, ND, NE, NJ, NM, NY, OH, OR, PA, RI, SC, SD, VT, WA, WI,WY. States without adult Medicaid dental benefits: AL, AZ, DE, FL, GA, HI, ID, KS, LA, MD, ME, MO, MS, MT, NH, NV, OK, TN, TX, UT, VA, WV. ^a Unadjusted survey-weighted proportions.