Do Adult Medicaid Benefits for Oral Health Reduce ED Visits?

Abstract

The previous ChristianaCare Health System (CCHS) study that examined the financial burden of dental-related Emergency Department (ED) visits within the ChristianaCare Health System between June 1, 2013, and June 22, 2018, provided evidence to support the claim that a large percentage of patients utilizing the ED for dental-related disease were uninsured, as well as the fact that the treatment the patients received was more costly and less effective than definitive dental care in a dental/oral surgery office. On October 1, 2020, adults (19-65) living in Delaware who were eligible for medical Medicaid coverage were enrolled in dental Medicaid coverage as part of their plans. This study aims to compare the previous study's results to the same population between the dates of October 1, 2020, and March 1, 2021, following the approval of adult Medicaid dental coverage and to determine if there was an increased utilization of dental benefits and a subsequent reduction in ED-related dental visits, as patients opted to seek care at dental/oral surgery offices.Data were retrospectively collected on all non-traumatic, dental-related problems presenting to the Wilmington and Christiana Emergency Departments between October 1, 2020, and March 1, 2021. Patients were categorized by the diagnostic code (ICD-10) used during their ED visits. Patient demographics and insurance coverage were obtained. The data were analyzed, and the treatment provided was determined for each visit based on the CPT code used. These results were then extrapolated and compared to the previous study's statistics to determine: 1) if the insurance coverage types and 2) subsequent volume of ED visits had significantly changed as compared to the pre-Medicaid dental coverage time period.After extrapolating the results of the 6-month time period (October 1, 2020, to March 1, 2021), it was determined that the overall distribution of insurance coverage types of those patients presenting to the ED did not significantly change when compared to the previous study (June 1, 2013, to June 22, 2018). Overall, the percentage of patients utilizing Medicaid insurance for ED-related dental visits was 56% before and after the institution of the dental benefits through Medicaid. However, the volume of patients presenting to the ED for dental-related concerns decreased following the addition of dental benefits within adult Medicaid.Based on the results exhibited in this study, since the addition of dental benefits to adult Medicaid in Delaware, the number of dental-related ED visits appears to have decreased as compared to those exhibited in the previous study, while the overall distribution of insurance coverage types did not appear to significantly change. This reduction in total volume of dental-related ED visits is suspected to be related to improved access to care with the addition of dental benefits to adult Medicaid. It is believed that with this improved access to care, along with continued community outreach and dental education, the volume of future dental-related ED visits can effectively continue to be reduced, and the shift toward the use of dental/oral surgery offices for more effective and definitive dental care can be promoted. Furthermore, this trend is suspected to lead to improved oral health throughout the community and a decrease in the total cost of care.