A new study from researchers at the University of Iowa examined the effect of the 2009 elimination of Medi-Cal adult dental benefits on service utilization and cost. Adult dental benefits are an optional benefit in Medicaid, and many states have eliminated or reduced these benefits when they have budgetary difficulties, such as the gaping deficits that California experienced during the recent Great Recession.
The results of the study indicate that, among the 3.5 million California adults who lost dental coverage, emergency department (ED) use increased. This increase in ED utilization both reduced savings from eliminating the benefits in the first place, as well as drove greater use of suboptimal care, and potentially delayed care, in an inappropriate setting. This group of adults had 1,800 additional ED visits annually after the 2009 elimination of benefits, and that represents around $1.3 million in additional ED spending on dental problems. That’s an additional 4.4 ED visits per month for dental reasons per 100,000 program beneficiaries.
Compounding this problem of ED use, which is a much more expensive place to receive care than an outpatient office, is that most EDs cannot perform tooth extractions or root canals that would ultimately address underlying dental issues. EDs can typically only prescribe medication to relieve pain or control infections until patients can find a dentist who will see them.
Other states have experienced similar patterns in utilization after eliminating or reducing dental benefits. Oregon and Maryland both saw increases in ED use for dental issues after eliminating Medicaid benefits. Oregon ultimately elected to restore its benefits.
Fortunately, California has partially restored adult dental benefits in Medi-Cal, and this research suggests that was a positive move, both for beneficiaries and how the state makes investments in the Medi-Cal program.