Medicaid Adult Dental Benefits and Oral Health of Low-Income Seniors

Objectives: Older adults are keeping their natural teeth longer than before, drawing calls for dental coverage under Medicare. While Medicare dental coverage would benefit all seniors, most vulnerable low-income seniors can potentially gain dental benefits through Medicaid. This study examined the association between state Medicaid adult dental benefits and access to dental care and oral health of low-income seniors.
Methods: Using Behavioral Risk Factor Surveillance System (BRFSS) data from 2014, we examined adults aged 65 years or more with annual household income less than $25,000. Outcomes included annual dental visit, loss of any permanent teeth and loss of all natural teeth. States were classified based on their Medicaid adult dental coverage into: no coverage, emergency only, limited and extensive. Multivariable logistic regressions were used to examine the association after adjusting for covariates, and applying appropriate weights to account for complex sampling design.
Results: More than 77% of low-income seniors had at least one permanent tooth extracted, about 24% had no natural teeth and only 46% visited a dentist in the past year, compared to 65%, 11%, 72% respectively, among seniors with income more than $25,000. States’ Medicaid adult dental coverage level was significantly associated with dental utilization, with low-income seniors residing in states with no dental benefits having 0.83 times the odds (95%CI=0.73-0.94), states with emergency only coverage having 0.81 times the odds (95%CI=0.72-0.91), and states with limited benefits having 0.89 times the odds (95%CI=0.80-0.98) of annual dentist visit as those residing in states with extensive dental benefits. There were no clear associations between the state Medicaid adult dental coverage and odds of partial or complete tooth loss.
Conclusions: States’ Medicaid adult dental coverage level is significantly associated with dental care utilization among low-income seniors. Providing comprehensive dental benefits under Medicaid may improve access among low-income seniors.