Impact of Medicaid dental coverage expansion on self-reported tooth loss in low-income adults

Abstract

Background: Low-income adults delay oral health care due to cost more than any other health care service. These delays lead to caries, periodontal disease, and tooth loss. Expanding Medicaid dental coverage has increased dental visits, but the potential impact on previously unmet oral health needs is not well understood.

Methods: In this analysis, the authors estimated the association between Medicaid dental expansion and tooth loss. Data on self-reported tooth loss among adults below 138% federal poverty guideline were obtained from the Behavioral Risk Factor Surveillance System. A difference-in-differences regression was estimated. Additional analyses stratified according to age and separated extensive and limited dental benefits.

Results: Expanding Medicaid dental coverage is associated with increased probability of total tooth loss of 1 percentage point in the total sample, representing a 20% relative increase from the pre-expansion rate. This increase was concentrated in states offering extensive dental benefits and was largest (2.5-percentage-point greater likelihood) among adults aged 55 through 64 years for whom both extensive and limited dental benefits were associated with total tooth loss.

Conclusions: Medicaid expansion with extensive dental benefits was associated with increased total tooth loss among low-income adults. This finding suggests that greater access to oral health care addressed previously unmet oral health needs for this population.

Practical implications: As public dental coverage continues to expand, dental care professionals may find themselves treating a greater number of patients with substantial, previously unmet, oral health needs. Additional research to understand the long-term effects of Medicaid dental insurance for adults on their oral health is needed.

Keywords: Affordable Care Act; Medicaid; Tooth loss; disparities; edentulism; insurance.

Figure 1:. Weighted Mean Tooth Loss Rates, by Expansion and Non-Expansion States

Figure 1 shows the year-by-year, weighted mean tooth loss rates for states which expanded Medicaid dental coverage (and states which did not expand Medicaid. Expansion states include states which expanded in 2014, as well as states who expanded after 2014 but before 2018.