Medicaid Adult Dental Benefits and Program Participation

Lipton, Brandy; Lipton, Brandy

Although all states cover preventive dental care for children on Medicaid, coverage is optional for adults. For example, between 22 and 27 state Medicaid programs covered preventive dental services for adults during 2000-2012, depending on the year. Overall, the percentage of adult enrollees with dental benefits fell from 70% to 40% over this period. Previous evidence suggests that dropping dental coverage for Medicaid enrollees is associated with more untreated dental caries and dental-related emergency room visits. However, there is little evidence to date of the extent to which those eligible for Medicaid value different benefits, including dental coverage. Anecdotal evidence suggests that many new Medicaid enrollees in Oregon immediately attempted to access dental benefits when the program was expanded in 2008, providing some support for the notion that enrollees value this optional coverage.

In this paper, we examine the relationship between Medicaid coverage of preventive dental benefits and participation in Medicaid among eligible adults using the 2001-2013 Annual Social and Economic Supplement of the Current Population Survey (CPS) (covering outcomes for calendar years 2000-2012). Dental policies by state and year were collected through internet search and contact with state health departments. We linked these state policies to information on Medicaid participation and demographic characteristics from the CPS.

We estimated the effect of Medicaid adult dental coverage on insurance status (Medicaid or uninsured) among eligible non-elderly adults not on Medicare using a linear probability models controlling for a range of demographic characteristics. State fixed effects were included to account for differences between states that do not vary over time, while year fixed effects accounted for national trends in Medicaid participation. Sample weights were used to produce nationally-representative estimates, and standard errors were clustered by state.

Our findings imply that participation in Medicaid is higher and the chance that a Medicaid-eligible adult is uninsured is lower in states that offer adult preventive dental benefits compared to those that do not. Specifically, we find that the chance that a Medicaid-eligible adult is uninsured is about 5 percentage points lower in states offering preventive dental benefits, a nearly 17% reduction in the uninsured rate among adults eligible for Medicaid. We also found that the uninsured rate among Medicaid-eligible adults is higher for men than women, whites and Hispanics compared to non-Hispanic blacks, those with higher income, childless adults, and those with more education or better health.

Medicaid enrollment increased and the number of Americans without health insurance decreased in 2014, in part due to Medicaid expansions to adults with incomes up to 138% of the federal poverty level in some states. Achieving and maintaining these increases in health insurance coverage requires strong participation in Medicaid among eligible adults. Our results indicate that state coverage of adult dental benefits may increase participation in Medicaid.

Association for Public Policy Analysis & Management

Panel Paper: Medicaid Adult Dental Benefits and Program Participation