ACEP: Medicaid Dental Coverage Does Not Prevent ER Visits

Posted on August 6, 2015

WASHINGTONAug. 5, 2015 /PRNewswire-USNewswire/ -- More than 2 percent of all emergency room visits are now related to non-traumatic dental conditions, despite the expansion of dental coverage under Medicaid.  A study published Monday in Health Affairsanalyzes the gaps in coverage and access that lead many Medicaid patients to visit emergency departments ("Medicaid Dental Coverage Alone May Not Lower Rates of Dental Emergency Department Visits").

The Health Affairs study correlates with statements issued in May by the American College of Emergency Physicians that more than half (56 percent) of emergency physicians responding to a poll say the number of Medicaid patients is increasing and that more than half of providers listed by Medicaid managed care plans could not offer appointments to enrollees.

"The large number of visits to ERs for dental conditions that could be treated in outpatient settings is proof that our health care system treats dental care differently than other preventive care," said Maria Raven, MD, FACEP, an associate professor of emergency medicine at the University of California, San Francisco and the study's senior author.  "Inadequate dental care has negative consequences for patients, including infection and tooth loss. Dental insurance should not be a luxury available only to the rich; it should be considered a necessity for everyone. Unfortunately, dental insurance for the poor is an exception rather than the rule."

The study examined county-level rates of emergency room visits for non-traumatic dental conditions in 29 states in 2010. They found that dental provider supply was associated with lower rates of emergency room visits for dental care by patients with Medicaid in rural counties, but not in urban counties, where some 90 percent of dental emergency visits occurred. This is partly due to the lack of dental coverage under Medicaid in some areas and the shortfall of dental providers in rural communities, as well as the dearth of dentists in urban areas willing to take on new Medicaid patients.

In urban areas, expanded Medicaid dental coverage did not appear to reduce dental emergency visits despite an adequate supply of dentists. These findings suggest that even in states whose Medicaid programs offer expanded dental coverage, patients may have difficulty locating dentists who accept Medicaid. The rate of dentists who accept Medicaid has been reported to be as low as 11 percent in Missouri, 15 percent in Florida and 20 percent in New York.

An estimated 8.3 million individuals are eligible to gain dental coverage through Medicaid expansion under the Affordable Care Act.  As of January 2013, some 45 million Americans were living in regions with shortages of dental care providers, particularly in rural areas. In coming years, the national supply of dentists is expected to decrease further as many current dentists retire. 

"It is likely that ERs will continue to provide care to individuals without adequate access to office-based dental care unless new dental service delivery models are developed to expand access in underserved areas, and unless more dental providers begin to accept Medicaid under the Affordable Care Act," said Dr. Raven.

The research on emergency room visits for dental conditions and Medicaid dental coverage was funded by the Agency for Healthcare Research and Quality, within the U.S. Department of Health and Human Services.

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. 

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