Emergency Department Dental Visits in a New Medicaid Program

Objectives: Beginning in May 2014, Iowa’s Medicaid expansion offered dental coverage to low-income adults (aged 19-64) through the new Dental Wellness Plan(DWP). DWP was designed to provide improved access to dental care compared to traditional Medicaid, with a wider provider network, higher reimbursements, and incentived preventive care. These features were hypothesized to contribute to reduced emergency department(ED) visits for non-traumatic dental conditions(NTDCs). This study evaluates trends in ED use during the program’s first 18 months.
Methods: We calculated rates of ED visits for NTDCs among DWP members with comparisons to the traditional adult Medicaid population(5/2014-9/2015). We also calculated rates of ED visits in Medicaid 18 months prior to expansion(11/2012-4/2014) to examine change over time. NTDCs included ICD-9 diagnoses of 521.00-529.00. Rates were calculated as number of ED visits per 1,000 months of member eligibility. We also examined rates of follow-up with a dentist within 60 days following the ED visit in both populations.
Results: From 2014-2015, DWP members had lower rates of ED visits for NTDCs than adults in traditional Medicaid (see Table). Rates of 60-day follow-up with a dentist were higher in DWP compared to traditional Medicaid (36.8% vs. 29.8%, respectively).
Conclusions: Reducing use of EDs for NTDCs offers potential cost savings for dental programs. Innovative program designs may reduce avoidable ED visits.