Emergency Department Visits for Dental Conditions Increase After Kentucky Medicaid Expansion

In 2014, Kentucky’s Medicaid program was expanded and access to adult dental coverage was increased for millions. However, the program’s growth has brought to light the problem of access to treatment. It has now been found that, since the program’s expansion, more people have used emergency departments (EDs) for treatment of their dental conditions than before the program went into effect.

In a new study published by Health Affairs, it was shown that many patients who enrolled in the Medicaid expansion program used local EDs for a variety of dental issues, many of which could have been prevented. The study authors used data from several state sources, and found evidence of significant problems that only arose after the Medicaid expansion took effect:

· Among adults who enrolled, the proportion who were discharged from EDs for dental or oral health conditions that could have been prevented with access to primary dental healthcare services rose from 22 percent in 2010 to 33 percent in 2014.

· The number of adults enrolled in the program who were discharged from EDs with dental or oral health conditions increased from 6,328 in 2013 to 18,844 in 2014.

· The number of discharges for uninsured adults fell, from 20,453 in 2013 to 7,796 in 2014.

· Medicaid enrollees who were discharged from an ED with a dental or oral health condition in addition to another chronic comorbid condition, like diabetes, increased from 41 percent in 2010 to 51 percent in 2014.

· In 2014, inflation-adjusted costs for ED discharges for Medicaid enrolled adults with dental or oral health conditions increased by over $4.2 million, or 219 percent.

After the expansion of the Medicaid program, the study authors found that the adults who enrolled were in poorer dental and general health when compared to previously covered adults. This was attributed to these adults facing greater challenges when attempting to access dental care. In fact, the research found that there was a great effort in Kentucky to help Medicaid enrollees understand their benefits and connect them with primary healthcare providers, but the same type of effort did not exist for the dental coverage portion of the plan.

As one of the study authors, Dr. Jane Grover, director of the Council on Advocacy for Access and Prevention at the American Dental Association (ADA), wrote, “In a state where — according to the ADA's Health Policy Institute – 1 in 5 low-income adults said their mouth and teeth were in poor condition, this increased use of EDs for dental care likely stems from unmet oral health needs that can also greatly affect overall health. While expanding coverage is an important first step in improving health outcomes, our findings suggest that this must be paired with appropriate support to increase opportunities for beneficiaries to more easily access the right dental care from the right provider.”