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Changes in emergency department dental visits after Medicaid expansion
Hawazin W. Elani BDS, PhD
Ichiro Kawachi MB.ChB, PhD
Benjamin D. Sommers MD, PhD
First published: 15 January 2020
https://doi.org/10.1111/1475-6773.13261
Citations: 2
Objectives
To estimate the effect of Medicaid expansion under the Affordable Care Act (ACA) on the frequency and payment source for Emergency Department (ED) visits for dental care.
Study Design
Retrospective, quasi‐experimental study.
Data Sources/Study Setting
We used the State Emergency Department Database to compare changes in ED visit rates and payment source for dental conditions among patients from 33 states. These states represent four distinct policy environments, based on whether they expanded Medicaid and whether their Medicaid programs provide dental benefits. We first assessed the number of ED dental visits before (2012) and after (2014) the ACA. Then, we used differences‐in‐differences regression to estimate changes in insurance for dental visits by nonelderly adults.
Principal Findings
Our sample contained 375 944 dental ED visits. In states that expanded Medicaid and offered dental coverage, dental ED visits decreased by 14.1 percent (from 19 443 to 16 709, for a net difference of 2734). By contrast, in the remaining three state groups, dental ED visits rose. Meanwhile, the expansion significantly increased Medicaid coverage and decreased the rate of self‐pay for ED dental visits.
Conclusions
Medicaid expansion, combined with adult dental coverage in Medicaid, was associated with a reduction in ED utilization for dental visits.
Please note that these rules have been final filed by the OSDB. They will take effect on 9/12/16.
| Rule Number | Agency | Tagline |
| 4715-3-01 | State Dental Board | Definitions |
| 4715-5-01.1 | State Dental Board | Requirements for initial licensure for dentists |
| 4715-5-02 | State Dental Board | Written work authorization |
| 4715-5-08 | State Dental Board | Denture identification |
| 4715-6-01 | State Dental Board | Standards and procedures for review of Ohio Automa… |
| 4715-8-02 | State Dental Board | Sponsors of continuing education |
| 4715-8-03 | State Dental Board | Standards for approval of biennial sponsors |
| 4715-8-04 | State Dental Board | Continuing education requirements for renewal or r… |
| 4715-9-01 | State Dental Board | Permissible practices of a dental hygienist |
| 4715-9-03 | State Dental Board | Requirements for licensure for dental hygienists |
| 4715-9-04 | State Dental Board | Dental hygiene teaching certificate |
| 4715-9-05 | State Dental Board | Practice when the dentist is not physically presen… |
| 4715-9-06 | State Dental Board | Dental hygienist participating in the oral health … |
| 4715-10-03 | State Dental Board | Application for oral health access supervision pro… |
| 4715-11-01 | State Dental Board | Basic qualified personnel; functions |
| 4715-11-02 | State Dental Board | Basic qualified personnel; functions |
| 4715-11-02.1 | State Dental Board | Monitoring nitrous oxide-oxygen (N2O-O2) minimal s… |
| 4715-11-03.1 | State Dental Board | Coronal polishing certification |
| 4715-11-03.2 | State Dental Board | Certified dental assistant; practice when the dent… |
| 4715-11-04 | State Dental Board | Application for registration as expanded function … |
| 4715-11-04.4 | State Dental Board | Expanded function dental auxiliary; practice when … |
| 4715-11-06 | State Dental Board | Non-delegable dental tasks and/or procedures |
| 4715-12-01 | State Dental Board | Permissible practices of a dental assistant radiog… |
| 4715-15-01 | State Dental Board | Enforcement |
| 4715-15-02 | State Dental Board | Representatives; appearances; communications; appl… |
| 4715-15-16 | State Dental Board | Reports and recommendations |
| 4715-17-01 | State Dental Board | Notice of regular and special meetings of the Ohio… |
| 4715-19-02 | State Dental Board | Procedures for accessing personal information |
| 4715-19-04 | State Dental Board | Confidential information |
| 4715-20-03 | State Dental Board | Disposal of wastes and sharps |
| 4715-21-01 | State Dental Board | Requirements for approval of treatment providers a… |
| 4715-40-01 | State Dental Board | Quality intervention program; Definitions |
Click on the rule number to go to the Register of Ohio website for details about the rule filing. Click here to send a comment to the JCARR committee or JCARR staff.
To view rule filing activity on all rules you are tracking, please visit your My Active Rules page on the RuleWatch Ohio website.
RuleWatch Ohio is sponsored by the Ohio Joint Committee on Agency Rule Review (JCARR). JCARR is a legislative committee consisting of members from the Ohio Senate and Ohio House of Representatives. The committee’s main function is to ensure that state agencies do not exceed their delegated law making authority through rules. For more information about JCARR visit: https://www.jcarr.state.oh.us or call (614) 466-4086.
***************************************************************************************************************
Dental Advocates Seek Scope Of Practice Changes To Address Coverage Gaps
With the demand for dental services expected to outpace Ohio’s supply of dentists in the next decade, advocates called on the General Assembly Wednesday to modify the state’s dental scope of practice laws.
Dental Access Now! Project Director David Maywhoor cautioned that without adding dental therapists and allowing dental hygienists to work at the top of their scope, Ohio could see even greater dental shortages by 2025.
“Unless we make changes to Ohio’s dental workforce, the result will exacerbate the access problem for underserved populations who forego basic dental care because they don’t live near a provider, they cannot pay for care or they have a limited oral health care understanding and literacy,” he told reporters during a conference call.
“We know now that this will impact the overall health of Ohioans living in underserved communities.”
Pointing to a U.S. Health Resources and Services Administration report, Mr. Maywhoor said Ohio needs at least 235 more dentists to meet current demand.
Unlike the national trend, Ohio’s dentist supply is expected to decrease over the next decade, going from more than 6,200 in 2012 to nearly 5,900 by 2025, he said. If this occurs, Ohio would be short more than 600 dentists to meet the demand – a decline he attributed, in part, to an aging dental workforce.
While the HRSA study suggests the supply of dentists is expected to fall short, the number of Ohio dental hygienists is projected to outpace need in the coming years, said Columbus hygienists Meagan Niezgodski.
According to HRSA data, she said, such an increase would leave 821 more hygienists than demand in 2025.
Competition, however, is already fierce for dental hygienist jobs in Ohio with many needing to take on several part-time positions, Ms. Niezgodski said. Increasing hygienists’ scope of practice would allow them to find more work and to address the needs of Ohioans living in one of the state’s 84 dental health professional shortage areas, she contended.
“Hygienists have the qualifications and training to work outside the private practice setting and work in the areas where the need for oral health care is strong, but the supply of dentists and dentist offices is not,” Ms. Niezgodski said. “It’s ironic to think of an oversupply of hygienists when so many Ohioans need basic preventative and restorative care.
“Freeing up hygienists to work in communities under the remote supervision of dentists can help ease the surplus while increasing access to care.”
Montgomery-based dentist Barry Gibberman said in addition to modernizing dental practice laws so professionals can practice to the full extent of their education and training, Ohio should expand the dental team to include dental therapists, who would also work under a dentist’s supervision.
These mid-level providers, who are trained in preventative and routine dental care, would expand the dental team’s reach, he said, adding that dental therapists have been successfully utilized in other states.
Mr. Gibberman urged lawmakers to support the group’s proposed legislation and address dental shortages in the state. He pointed to the adoption of similar practice changes in other health fields.
“This addition to the dental team will provide a more efficient, community-based approach to help improve access to much-needed care,” he said. “It is with urgency that we call on our lawmakers to address the dental provider shortage now so we don’t fall further behind in the coming decade.
Mr. Maywhoor said while Dental Access Now! has drafted its proposed legislation, it’s been working to identify a lawmaker to carry the measure. The organization announced a dental therapist legislative proposal last fall.
Rep. Terry Johnson (R-McDermott) and Sen. Joe Uecker (R-Loveland) previously sponsored companion bills (SB237, HB463, 130th General Assembly) that would provide incentives to dentists for working in underserved areas and expand the practice scope for some dental professionals.
The House’s version of the bill, which among other things was modified to allow hygienists to apply desensitizing agents, cleared the legislature and was signed into law late last year.
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