Abstract
BackgroundIn Iowa from 2014 to 2017, there were 2 separate public dental benefit programs for Medicaid-enrolled adults: one for the Medicaid expansion population called the Dental Wellness Plan (DWP), and one for the traditional, non-expansion adult Medicaid population. The programs differed with respect to reimbursement, administration, and benefit structure. This study explored differences in patterns and predictors of dentist participation in the two programs.MethodsAuthors sent a survey to all private practice dentists in Iowa (n = 1301) 2 years after DWP implementation. Descriptive, bivariate, and logistic regression analyses were used to examine patterns and predictors of dentist participation in Medicaid and DWP.ResultsOverall rates of dentists’ acceptance of new Medicaid and DWP patients were 45 and 43%, respectively. However, Medicaid participants were much more likely than DWP participants to place limits on patient acceptance. Adjusting for other factors, practice busyness was the only significant predictor of DWP participation, and practice location was the only significant predictor of Medicaid participation. Dentists who were not busy enough were more than twice as likely to participate in DWP compared to others, and dentists in rural areas were almost twice as likely to participate in Medicaid compared to dentists in urban areas.ConclusionsDentist participation in Medicaid is an ongoing concern for states aiming to ensure access to dental care for low-income populations. We found distinct participation patterns and predictors between a traditional Medicaid dental program and the DWP, suggesting different motivations for participation between the two programs.
Highlights
In Iowa from 2014 to 2017, there were 2 separate public dental benefit programs for Medicaid-enrolled adults: one for the Medicaid expansion population called the Dental Wellness Plan (DWP), and one for the traditional, non-expansion adult Medicaid population
Prior to the Affordable Care Act (ACA), low-income adults were only eligible for Medicaid if their income was at or below 133% of the Federal Poverty Level (FPL) and they were “categorically eligible”; whereas the ACA expanded eligibility to all adults with income at or below 133% FPL regardless of categorical eligibility
In this cross-sectional study of dentist participation in 2 separate public dental benefit programs in Iowa, we found important differences in participation patterns and factors associated with participation between the 2 programs
Summary
In Iowa from 2014 to 2017, there were 2 separate public dental benefit programs for Medicaid-enrolled adults: one for the Medicaid expansion population called the Dental Wellness Plan (DWP), and one for the traditional, non-expansion adult Medicaid population. Access to dental care for adults in the U.S is an increasing concern, especially for those who have low income. While dental utilization among children and seniors has increased in the past decade, utilization among adults has declined [1]. Adults are more likely than children or seniors to experience financial barriers to care [2]. These financial barriers are largely related to state-by-state variability in dental coverage for adult Medicaid enrollees. Expansion-related improvements in access to dental care were dependent on states’ decisions to: 1) expand their Medicaid program, 2) include dental benefits for Medicaid-enrolled adults, and 3) extend those
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