California ended Medicaid for dental care: Big mistake?

After California ended Medicaid coverage for dental care, emergency room visits for dental problems shot up. The same thing happened in Oregon: ER visits for dental care doubled. "We know states are facing difficult budget decisions. This research indicates there may be unintended consequences with patients feeling forced to rely on emergency-room visits," says Peter Damiano. (Credit: iStockphoto)

Dropping Medicaid coverage for dental visits may actually cost states more money than keeping it.

California ended adult dental coverage under Medicaid in mid-2009, a move that resulted in a loss of benefits for about 3.5 million low-income adults. After the change, adults made more than 1,800 additional visits annually to hospital emergency departments for dental care.

California spent $2.9 million each year in Medicaid costs for dental care in emergency departments, up from $1.6 million before the state eliminated the adult dental care benefit. That’s a 68 percent increase in costs, when factoring inflation.

Since 2010, five states— Arizona, Massachusetts, Pennsylvania, South Carolina, and South Dakota—have either curtailed or eliminated adult dental benefits under Medicaid. Other states, including Illinois and Missouri, are considering some limits to coverage.

Tooth extraction and root canals

“I think the important point here is although the Medicaid dental benefit for adults is optional, savings derived from dropping the benefit are somewhat eaten up by the increased costs from adults seeking dental care in hospital emergency departments,” says Astha Singhal, a postdoctoral researcher in the University of Iowa College of Dentistry and corresponding author on the paper that is published in the journal Health Affairs.

Fifteen states, including Iowa, currently offer comprehensive dental benefits for low-income adults.

Under the Affordable Care Act, the federal government will pick up about 90 percent of the Medicaid bill to states that offer dental benefits to adults through 2020. After that, the costs will shift gradually to states.

“We know states are facing difficult budget decisions. This research indicates there may be unintended consequences with patients feeling forced to rely on emergency-room visits,” says Peter Damiano, director of University of Iowa’s Public Policy Center and a contributing author of the paper.

“Most ERs can’t extract teeth or start root canals. They can only prescribe pain medication and/or antibiotics. This may delay treatment but is unlikely to prevent the need for the dental care at some point in the future.”

No other options

The study covered 2006 to 2011, meaning it looked at emergency department use for dental problems before and after California eliminated the Medicaid dental benefit. California partially restored the benefit last year. Data came from the Agency for Healthcare Research and Quality, a branch of the US Department of Health and Human Services.

There were an additional 4.4 emergency department visits per month for dental problems per 100,000 enrollees after California eliminated the benefit. That equates to more than 1,800 added emergency department visits per year for dental needs by the adult Medicaid population.


Young adults, members of racial/ethnic minority groups, and urban residents were disproportionately affected by the change, the study shows.

Other states have shown similar increases: ER visits in Oregon doubled for unmet adult dental needs after eliminating the Medicaid benefit in 2003. The state has since restored the benefit. And, Maryland experienced a 12 percent increase in the rate of emergency department visits by adults for dental care after dropping the Medicaid benefit in 1993.

“Providing dental coverage facilitates access to dental care, whereas when cutting dental benefits, patients have no option but to go to hospital emergency departments, which are not equipped to treat them appropriately,” Singhal says.

Other researchers from University of Iowa and from the California Department of Health Care Services contributed to the work.

Source: University of Iowa