The elective status of adult dental coverage under Medicaid in California has led to a 32% increase in emergency dental care visits during a six-year period, according to an article published in the May 2015 Health Affairs.
“The California experience provides evidence that eliminating Medicaid adult dental benefits shifts dental care to costly emergency departments that do not provide definitive dental care,” the study reported.
Health Affairs said dentists who practice primarily in populated, more affluent areas provide the majority of dental services in the state. In recent years, many of the state’s poorer adult residents, including minority groups, seek out alternative emergency services once the California Medicaid program eliminated all adult dental benefits in July 2009. Pediatric patients still receive “essential” dental benefits, a position strengthened by the federal Affordable Care Act.
The study authors said, “As a result, the vast majority of patients who visit an emergency department with a dental problem do not receive definitive dental treatment. Instead, they receive only prescriptions for painkillers, antibiotics, or both.”
In May 2014, the state partially restored some dental benefits for adult enrollees in Medicaid, including preventive care, restorations, endodontic treatment for anterior teeth, and full dentures. The authors attempted to study the costs associated with emergency room visits and Medicaid savings.
“We found that Medicaid spent about 78% more ($2.85 million per year after the policy change, compared to $1.60 million per year before it) on ED dental visits after the elimination of adult dental coverage,” the report said, adding “The increased costs of ED visits were not enough to offset the savings to Medicaid after the elimination of dental coverage. However, these ED costs offer almost no benefit in terms of the actual resolution of the dental problem for the enrollees.”
Several states are considering altering coverage for adults in Medicaid programs, particularly as plans expand under the Affordable Care Act. The study’s authors concluded that an increase in emergency visits for dental care does not effectively replace the dental office as a source of care.
To view an abstract of the study, click here.