By Andrew M. Seaman
(Reuters Health) - After dental benefits were removed from California’s public health insurance for the poor, emergency room visits for dental problems went up, a new study shows.
Removing comprehensive dental benefits from the state’s Medicaid program in 2009 led to nearly 1,800 additional ER visits per year for dental problems, the researchers estimate.
“California used to provide comprehensive dental benefits for adults,” said Astha Singhal, the study’s lead author from the University of Iowa in Iowa City. “During the recent economic recession they were looking for ways to cut costs and save money.”
The findings are especially important as U.S. states either expand or consider expanding their Medicaid programs under the 2010 Affordable Care Act (ACA) - also known as Obamacare, Singhal said.
The study, published May 4 in Health Affairs, looked at ER visits for Medicaid-enrolled adults in California between 2006 and 2011, which is three years before and two years after dental benefits were removed from the program.
Overall, 113,309 adults on California’s Medicaid program made 121,869 ER visits for dental problems in those six years.
For every 100,000 people on Medicaid there, there were about 42 ER visits per year before the policy change in 2009, and about 56 visits after the change.
Applying those findings to the 3.48 million Californians on Medicaid means that more than 1,800 additional ER visits for dental problems occurred each year after the benefits were stopped.
The most common diagnoses during those visits were “other dental disease,” problems inside the tooth and cavities.
The researchers say the policy change significantly affected younger adults, whites, blacks, Hispanics and those living in large metropolitan areas.
After adjusting for inflation, the costs of dental ER visits increased by 68% after the policy change, according to the report.
Dr. Peter Damiano, the study’s senior author, said the state’s Medicaid program likely still paid for some of the care people received in the ER for dental problems, because it’s often billed as medical services.
“They’re usually giving them antibiotics and some pain killers,” said Damiano, who is from the University of Iowa Public Policy Center.
Since those medications don’t necessarily treat the underlying dental problem, he said the dental treatments get pushed back.
“The money being spent on them at the (ER) is basically being wasted,” Damiano said, adding that those additional visits add to already crowded waiting rooms.
Singhal said California reinstated some - but not all - of the Medicaid dental benefits that were cut in 2009, but other states are currently looking at possible dental benefit cuts.
While the ACA guarantees dental coverage for children on Medicaid, Damiano said the law “did not change the coverage for dental care among adults in Medicaid.”
“I think in this case the major takeaway is that there are unintended consequences that need to be evaluated when you make policy decisions,” he said.
Health Affairs 2015.