Examining The Effects of Expanding The Medicaid Adult Dental Benefit
The Department of Health Policy recently prepared an evaluation report for the Virginia Department of Medical Assistance Services (DMAS) that examined the effects of the expanded Medicaid Adult Dental Benefit on Emergency Department utilization in Virginia hospitals for non-traumatic dental visits. Presented to DMAS in March 2025, the report was authored by Department of Health Policy professor and interim chair Dr. Peter Cunningham Ph.D.; Healthcare Policy and Research Ph.D. candidate and VCU School of Dentistry Associate Professor Shillpa Naavaal, B.D.S., M.S., M.P.H.; Department of Health Policy Healthcare Data Analyst and incoming HCPR Ph.D. student Sherline Pierre-Louis; and Department of Health Policy Research Assistant Mallory Brown.
On July 1, 2021, Virginia implemented comprehensive dental coverage for all Medicaid-enrolled adults. This allowed thousands of adult Virginians to receive full dental coverage for the first time. Prior research had shown that lack of access to preventive and outpatient dental care services led to greater use of hospital emergency departments for non-traumatic dental issues. Therefore, in studying the effect of the Medicaid adult dental benefit, researchers expected that dental-related ED visits would decrease after the dental benefit was implemented. This report showed the results of an evaluation assessing the effects of the adult dental benefit on dental-related ED use.
Using Medicaid administrative claims data, Department of Health Policy researchers conducted an analysis of trends in dental-related ED use between July 2019 and June 2023 (two years before and two years after the start of the new dental benefit). The major findings from this analysis are:
- Young adults (ages 21-34) benefited the most from the new dental benefit in terms of a decrease in dental-related ED visits. There was a modest 6% decrease in dental-related ED use between the year prior to the start of the benefit and the 2nd year after the benefit (1.4 visits per 10,000 members). However, a difference-in-difference analysis suggests a larger impact of the new benefit for young adults – a decrease of 7.5 ED visits per 10,000 members compared to children and youth, who already had dental coverage and were therefore unaffected by the new benefit.
- Most adult members (70%) did not use preventive or other outpatient dental services during the first year of the new benefit, and they experienced a 24% increase in dental-related ED visits during the study period. In contrast, members who used preventive dental care during the first year of the new dental benefit saw no change in dental-related ED visits.
- There has been a general upward trend in dental-related ED visits after a sharp decrease during the start of the COVID-19 pandemic. This is consistent with more general trends in use of the ED among Medicaid members, and may reflect changes in Medicaid member characteristics and health system factors that are external to Medicaid.
In sum, there is compelling evidence that the new adult dental coverage has already benefitted young adults, who have by far the highest rates of dental-related ED visits among all age groups. Greater use of the dental benefit among Medicaid members will likely result in even greater decreases in ED use in the future.
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