Impact of Oregon's priority list on Medicaid beneficiaries

Synthesizing 30-years of adult medicaid dental policy research: A scoping review to identify gaps and opportunities

Objective

Despite the importance of Medicaid for the oral health of low-income adults, the extent to which Medicaid dental policy variation influences outcomes is unknown. This study aims to review the evidence evaluating adult Medicaid dental policies to synthesize conclusions and motivate future research.

Data sources

A comprehensive search of academic literature published in English between 1991 and 2020 was conducted to identify studies which evaluated an adult Medicaid dental policy for its effect on outcomes. Studies strictly involving children, policies not related to adult Medicaid dental coverage, and non-evaluation studies were excluded. The data analysis identified the policies, outcomes, methods, populations, and conclusions of the included studies.

Results

Among the 2731 unique articles extracted, 53 met the inclusion criteria. 36 studies evaluated the effect of expanding Medicaid dental coverage, which was found to consistently increase dental service visits (21 studies) and reduce unmet dental needs (4 studies). Provider density, reimbursement rates, and level of benefits appear to influence the effect of expanding Medicaid dental coverage. The evidence for changing Medicaid benefits and reimbursement rates were mixed for its impact on provider participation and emergency dental services. Few studies examined how adult Medicaid dental policies impact health outcomes.

Conclusions

Most of the recent research has focused on evaluating the effect of expanding or reducing Medicaid dental coverage on dental service utilization. Future research investigating the impact of adult Medicaid dental policies on clinical, health, and wellness outcomes remains warranted.

Clinical significance

Low-income adults are responsive to Medicaid dental policy changes and utilize more care with more generous coverage. Less is known about how these policies influence health.

Impact of Medicaid dental coverage expansion on self-reported tooth loss in low-income adults

BACKGROUND

Low-income adults delay oral health care due to cost more than any other health care service. These delays lead to caries, periodontal disease, and tooth loss. Expanding Medicaid dental coverage has increased dental visits, but the potential impact on previously unmet oral health needs is not well understood.

METHODS

In this analysis, the authors estimated the association between Medicaid dental expansion and tooth loss. Data on self-reported tooth loss among adults below 138% federal poverty guideline were obtained from the Behavioral Risk Factor Surveillance System. A difference-in-differences regression was estimated. Additional analyses stratified according to age and separated extensive and limited dental benefits.

RESULTS

Expanding Medicaid dental coverage is associated with increased probability of total tooth loss of 1 percentage point in the total sample, representing a 20% relative increase from the pre-expansion rate. This increase was concentrated in states offering extensive dental benefits and was largest (2.5-percentage-point greater likelihood) among adults aged 55 through 64 years for whom both extensive and limited dental benefits were associated with total tooth loss.

CONCLUSIONS

Medicaid expansion with extensive dental benefits was associated with increased total tooth loss among low-income adults. This finding suggests that greater access to oral health care addressed previously unmet oral health needs for this population.

PRACTICAL IMPLICATIONS

As public dental coverage continues to expand, dental care professionals may find themselves treating a greater number of patients with substantial, previously unmet, oral health needs. Additional research to understand the long-term effects of Medicaid dental insurance for adults on their oral health is needed.

Children in the Oregon Health Plan: how have they fared?

This study examines the impact of the Oregon Health Plan (OHP) on children's access to care. A telephone survey was conducted in 1998 of two groups of children: OHP enrollees and food stamp recipients not enrolled in OHP. Much of OHP's impact has been realized by the simple extension of health insurance coverage to Oregon's low-income children. The availability of insurance significantly increased the use of physician visits and dental care. The priority list had little effect on children, affecting only 2 percent of OHP children surveyed, most of whom succeeded in getting the service anyway. Thus, despite the negative publicity prior to its implementation, there is no evidence that "rationing" under OHP has substantially restricted access to needed services for children.

Impact of the Oregon Health Plan on children with special health care needs

OBJECTIVE

Although an increasing number of Medicaid children are enrolled in Medicaid managed care plans, little is known about how children with special health care needs fare under such programs. Of particular concern is the ability of such children to navigate a managed care system and gain access to specialty and other services. This study compares the managed care experiences of children with and without special care needs in the Oregon Health Plan.

METHODOLOGY

Telephone surveys were conducted with a sample of parents of children enrolled in the Oregon Health Plan. Three groups of children were sampled: Supplemental Security Income (SSI) children with disabilities, children with asthma, and children without special health care needs. Descriptive and multivariate analyses were conducted to determine the impact of Medicaid managed care on access and satisfaction.

RESULTS

Children with disabilities in managed care plans did not experience any more difficulty accessing needed specialty care than did those without special health care needs. Children with asthma, however, reported higher levels of unmet need. There were no differences in access between children with disabilities enrolled in managed care and those children with disabilities remaining in fee-for-service.

CONCLUSIONS

Unlike SSI children with disabilities, children who were not SSI-eligible but had asthma seemed to have difficulty obtaining some services. These children were not eligible for the same consumer protections afforded SSI children by Oregon. If states want to enroll all children with special health care needs into managed care programs, they must develop mechanisms for identifying such children and ensuring that they receive medically necessary services.