Since its passage in 2010, the Affordable Care Act (ACA) has significantly decreased the uninsured rate, particularly among low-income adults. This is, in large part, the result of expanded Medicaid coverage. And while the ACA does not include adult dental coverage as an essential health benefit, and states are not required to cover dental care for adults enrolled in Medicaid, a recent study on emergency department dental visits finds that the ACA’s Medicaid expansion has helped improve access to care in states that cover adult dental. The findings underscore the need to stabilize state Medicaid programs, incentivize Medicaid expansion, and provide comprehensive Medicaid adult dental benefits.

The availability of Medicaid adult dental benefits varies by state and ranges widely from only covering emergency treatment in some states to full comprehensive care in others. As of 2019, four states do not have Medicaid adult dental coverage and only 35 states plus the District of Columbia provide dental coverage beyond emergency treatment.

Without adequate coverage or access to affordable dental care in their communities, patients often turn to the hospital emergency department (ED). However, EDs generally are not staffed with dental providers and cannot adequately address underlying oral health problems, leaving patients with ongoing untreated dental needs and contributing to higher health care costs. In 2015, dental-related emergency department visits cost the health care system nearly $2 billion. However, the combination of Medicaid dental coverage and the expansion of Medicaid eligibility under the ACA can help bend that curve and avert such costly ED visits.

The study found that states that both offer adult dental benefits and expanded their Medicaid program have the lowest rates of dental-related ED visits. Both states that offer Medicaid adult dental benefits, but have not expanded their Medicaid programs, and those states that did expand their Medicaid programs, but do not offer Medicaid adult dental benefits, have shown an increase in dental-related ED visits. Only those states that have taken advantage of both expanding Medicaid and offering adult dental benefits have shown decreased dental-related ED visits.

Moreover, the study shows that Medicaid expansion increased Medicaid coverage and thus reduced the self-pay/uninsured rate. Both patients with Medicaid coverage and those who are uninsured and/or pay out of pocket had decreased dental-related ED visits.

The combination of proactive policies to expand Medicaid and cover adult dental benefits can improve access to essential oral health care and significantly decrease dental-related ED visits. Many states are recognizing the important role that Medicaid expansion and adult dental coverage play in increasing access to care. In June, Oklahoma voters approved a Medicaid expansion ballot initiative which will take effect in July 2021. Moreover, there is movement in West Virginia and New Hampshire to establish an adult dental benefit under their state Medicaid programs. In addition to a robust oral health care workforce, such efforts may eliminate the need for emergency dental care entirely, guiding patients to outpatient and community-based dental providers that can adequately address underlying oral health needs.

Caroline Le, Dental Access Project Intern