The Impact of Adult Medicaid Dental Coverage on Utilization and Expenditures

The provision of dental coverage for adults is not required by the PPACA (source:  KFF).  As medical costs rise, employers respond by reducing benefits and eliminating coverage.  Oral health care costs and dental insurance in particular have been subject to cuts in benefits and coverage.  According to the National Association of Dental Plans, 60 percent of the population had dental benefits (NADP, 2013).    This is troubling as uninsured individuals pay about twice as much out of pocket for dental services compared to insured individuals.

Dental care is necessary for all individuals as oral health is very much related to general physical health.  Medical studies have shown links between periodontal disease and diabetes, heart disease and obesity among other diseases (American Dental Association Oral health topics 2007). 

This paper analyses the determinants of dental expenditures and utilization.  The data are drawn from the Medical Expenditure Panel Survey (MEPS).  The MEPS Household component and Dental Visits data are used for survey years 1996 through 2013.  Exploiting state-level information on adult Medicaid Dental availability, we analyze the impact of this program on utilization and expenditures.  A Linear Probability Model and a Probit model each measure the probability of any dental visit.  We then examine dental care expenditures using quantile regression. 

Preliminary results indicate that private dental coverage is more likely for those with higher levels of education, females, and those with higher incomes.  Hispanics are least likely to have private dental insurance.  Predicted dental utilization and expenditures increase with age and with higher education levels.  Expenditures are highest for whites; and African Americans are predicted to spend the least on dental care.  In particular, the presence of private dental insurance versus Medicaid coverage has a great impact on dental expenditures.  For whites, having private dental insurance triples expenditures.  Both African Americans and Hispanics are predicted to have practically no dental use when they are without coverage.  Clearly the policy implications are especially pertinent for African American and Hispanic groups.  Since dental health can have a large impact on overall physical health, it is important to improve public coverage to these vulnerable groups so that they may maintain their oral health as well as their physical health.

Our results will provide evidence as to whether Medicaid has played a significant role in providing dental care for affected groups.

Key terms: dental utilization, dental expenditures, Medicaid, health care, health disparities, public policy