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The Impact of the ACA Medicaid Expansions on Dental Visits By Dental Coverage Generosity and Dentist Supply
Low-income adults in the US have historically had limited access to dental coverage and poor dental health outcomes. We examined the effects of the Affordable Care Act Medicaid expansions on dental visits among low-income adults focusing on the generosity of dental coverage and heterogeneity in effects by dentist supply by using data from the 2012, 2014, and 2016 Behavioral Risk Factor Surveillance System surveys. The main analytical sample included nearly 117,000 individuals below 138% FPL. We employed a quasi-experimental difference-in-differences design to identify the impact of the state Medicaid expansions on having a dental visit in the past 12 months by generosity of dental coverage and dentist supply.Medicaid expansions were associated with a nearly 6 percentage-point increase in the likelihood of any dental visits in 2016 (over 10% increase from pre-expansion rate) for individuals in Medicaid expanding states with extensive dental benefits. This increase however was concentrated in states with high dentist supply with no evidence of improvement in utilization in states with limited dental coverage or low dentist supply.Expanding Medicaid with generous dental coverage improved dental care use only in areas with high dentist supply with no evidence of benefits with low dentist supply or less generous coverage. Improving access to dental care may require both generous coverage and supply-side interventions to increase dentist availability.
