202674 Impact of Eliminating Medicaid Dental Benefits on Access, Utilization, and Cost

Sunday, November 8, 2009

Matthew Carlson, PhD , Department of Sociology, Portland State University, Portland, OR
Neal Wallace, PhD , Division of Public Administration, Portland State University, Portland, OR
David M. Mosen, PhD, MPH , Kaiser Permanente Center for Health Research, Portland, OR
Bill Wright, PhD , Providence Center for Outcomes Research and Education, Portland, OR
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.

Learning Objectives:
Describe how changes in dental coverage influence patients access to care and system level costs of care. Identify the impact of loss of Medicaid dental benefits on dental care access, utilization, and cost. Evaluate the effects of insurance coverage on oral health in a low income population.

Keywords: Oral Health, Access to Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Health Services Researcher with a PhD, several publications in this area, and several years of experience conducting research and publishing the results.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Policies to Improve Oral Health
See more of: Oral Health