Coverage expansion won't cut ER visits for dental care

Uninsured patients increasingly turn to the emergency department for dental healthcare needs, but expanding Medicaid's dental coverage won't reduce ED traffic, according to a study published in Health Affairs.

Katie Fingar, a research leader at Truven Health Analytics, and her team, analyzed ED visits in 2010 for non-traumatic dental care in 29 states and found that 2 percent could have been avoided. They also found no association between areas that increased Medicaid coverage for dental care and reduced ED usage.

In rural counties with a wide array of available dental providers, however, expansion tracked closely with a drop in ED visits. These results suggest that access to care, rather than coverage, is what makes a difference, said co-author Maria Raven of the University of California-San Francisco, especially since many dentists will not treat Medicaid patients due to the program's low reimbursement rates. For example, according to the study, only 20 percent of dentists in New York accept Medicaid, while in Missouri only 11 percent participate in the program. They predict access issues will increase as dentists retire in coming years.

Patients without access to dentists often put off care until their problems become worse, according to the study, which cited 2012 research that found ED visits for minor dental conditions increased 41 percent from 2001 to 2008, compared to a 13 percent increase for all other conditions.

Medicaid coverage for dental care varies state by state. Many providers were disappointed with the Affordable Care Act's (ACA) failure to address dental coverage, according to a June report from Pew Charitable Trusts.  In recent years, many states, even those that refused to expand Medicaid under the ACA, have expanded their programs' dental benefits, including Virginia, Colorado, California, South Carolina and Indiana.

To address these issues, researchers suggest the industry treat dental care as preventive care, dental clinics establish their own EDs and insurers broaden lower-cost dental coverage. "There are ways to build the dental services within Medicaid," Fingar told the Washington Post. "That's a good option because the alternative clearly is not working."

To learn more:
- read the study abstract
- here's the Pew report
- check out the Post article

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