Impact of Eliminating Medicaid Dental Benefits on Access, Utilization, and Cost

Objective: A common response to increased fiscal pressure in state Medicaid programs is the elimination of dental benefits. However, this strategy may result in minimal cost savings and have negative consequences for the health of Medicaid enrollees.

Methods: The current study is the only current study that examines both system and individual impacts of dental benefit cuts. Data come from two sources: Medicaid claims data (n=21,634) covering the period before and after Medicaid dental benefits were eliminated in Oregon in 2003; and a survey of Oregon Health Plan enrollees (n=2783) covering 3 years after benefit cuts.

Results: Analyses of claims data showed significant increases in the odds of dental related ED visits (75%) and dental related ambulatory medical care visits (97%). Analyses of Self-reported surveys during this time period indicated that after adjusting for important covariates Medicaid members without dental benefits had nearly three times the odds (OR=2.863, p=.001) of unmet dental need, and only one-third the odds (OR=.340, p=.001) of getting annual dental checkups, relative to those whose Medicaid coverage included dental benefits.

Conclusions: Combined evidence from both analyses suggests that cost savings associated with the elimination of dental benefits may be dampened by increased ED and outpatient utilization for dental problems, and resulted in significant unmet dental health care needs among vulnerable low income populations.