U-M Study Finds Medicaid Expansion Positively Affects Oral Health

A University of Michigan (U-M) study suggests that Medicaid’s dental coverage can improve the oral health of low-income individuals enrolled in the program in ways that help with their work and job searches. Findings from the study, “Beneficiaries’ Perspectives on Improved Oral Health and its Mediators After Medicaid Expansion in Michigan: A Mixed Methods Study,” can help inform policy decisions about the benefits of providing Medicaid dental coverage.

Changes in the economy and job loss due to the COVID-19 pandemic have led to an uptick in the number of people enrolled in the program. The Kaiser Family Foundation reports that from February 2020 to September 2020 Medicaid/Children’s Health Insurance Program enrollment increased in every state.¹  However, Medicaid coverage varies from state to state, making it hard for adults and children to access dental care. For years, states have been leading efforts to expand access to dental care for children and adults who receive benefits through Medicaid.

With a focus on the state’s Medicaid expansion, called the Healthy Michigan Plan, researchers from the U-M Institute for Healthcare Policy and Innovation used a survey and interviews to assess the impact of dental coverage provided to low-income residents enrolled in the plan.

The Healthy Michigan Plan provides basic dental services for residents who have an income at or below 133% of the federal poverty level—$33,000 for a family of four, or $16,000 for an individual. Dental checkups, prophylaxis, X-rays, extractions, dental composites, dentures and partial dentures are covered under the plan. 

Researchers found 60% of the 4,090 enrollees surveyed had visited a dentist at least once since enrolling in the Healthy Michigan Plan a year or two earlier. Among those who saw a dentist in that time, 57% said their oral health had improved since enrolling. Most of the survey respondents had no health insurance coverage in the year prior to enrolling in the Healthy Michigan Plan. Additionally, half of survey respondents had jobs or were self-employed; however, their incomes were low enough to qualify for the state’s plan. Forty-percent of all survey respondents, with jobs or without, stated their oral health had improved since they enrolled. 

Of those who were unemployed and reported improved oral health, 59.9% of enrollees said the coverage helped them when looking for a job. Beneficiaries who had jobs and reported improved oral health were more likely to report the Healthy Michigan Plan’s coverage improved their job performance (76.1%), compared to 65% who were employed but had not experienced improvements in their oral health. 

“The Healthy Michigan Plan’s dental coverage enabled many to get the dental care they needed,” notes lead author Edie Kieffer, MPH, PhD, a professor emerita at the U-M School of Social Work. “In our interviews with enrollees, people talked about the great impact of having this dental coverage. People told us that, without dental coverage, they had to have their teeth pulled. They used their new coverage to get dentures, which improved their appearance, employment options, and ability to eat. Dental coverage helped people address dental infections and get preventive care.”

Providing dental benefits also cut down on the number of people who turn to the hospital emergency department for urgent oral healthcare needs, as some enrollees reported previously presenting to the hospital for emergency dental care.

These findings, published in the Journal of Public Health Dentistry, reinforce support for providing dental benefits to Medicaid beneficiaries, as the authors suggest policymakers consider the importance of Medicaid dental coverage in reducing oral health disparities and improving the health and socioeconomic well‐being of low‐income adults.

REFERENCE

1. Corallo B, Rudowitz R. Analysis of Recent National Trends in Medicaid and CHIP Enrollment. Available at: kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/. Accessed March 25, 2021.