Increase of Non-Traumatic Dental Visits to Emergency Departments After Medicaid Expansion

Objectives: Rhode Island (RI) expanded its Medicaid program under the Affordable Care Act (ACA) on January 1, 2014 which included comprehensive adult dental coverage. We examined the effect of Medicaid expansion on the rate of non-traumatic dental visits (NTDV) to emergency department (ED) in comparison to other ambulatory care sensitive conditions (ACSC) such as asthma and back pain, and long bone fracture as a control.
Methods: RI Hospital Discharge Data and Medicaid Monthly Enrollment Report for calendar year 2013-2014 were used in this study. Annual and monthly visit rates for 24 months of observation were calculated, and interrupted time series analysis was used to examine the effect of Medicaid expansion for each of the outcomes (NTDV, ACSC, long bone fracture). Further subgroup analysis was conducted by age and gender.
Results: The annual number of visits due to NTDV increased from 2484 visits in 2013 to 3795 visits in 2014 following the expansion. The rate of NTDV increased by 34.8/100,000 enrollees immediately and significantly after the expansion (p=0.0023), amounting to more than 1000 additional ED visits. ED visits due to asthma and back pain declined immediately after the expansion, but the decline wasn’t significant. ED visits due to trauma had no significant changes during the study.
We found a significant increase in NTDVs among adults (43 visits/100,000 enrollees, p=0.018), but not among children (11 visits/100,000 enrollees, p=0.092). Both males and females had an immediate and significant increase in NTDVs after the expansion, but this effect was sustained only among males.
Conclusions: Rates of NTDVs increased among adults after the expansion, while that of ACSC and trauma did not. This implies that extending coverage for dental care did not immediately translate to access to primary and non-urgent dental care, possibly due to high pent-up demand and insufficient number of dental providers accepting Medicaid.