The Social and Economic Impact of Eliminating Medicaid Dental Benefits: Evidence from the Oregon Health Plan

Matthew Carlson, Principal Investigator
carlsonm@pdx.edu
503-725-9554

Co-Investigators: David Mosen, Kaiser Permanente Center for Health Research; John McConnell, Department of Emergency Medicine at Oregon Health and Science University (OHSU); Bill Wright, Providence Health Systems, Center for Outcomes Research and Education; and Neal Wallace, School of Community Health at Portland State University (PSU)

Sponsor: Robert Wood Johnson Foundation through the Office for Oregon Health Policy and Research

Links: http://www.oregon.gov/OHPPR/OHREC/Docs/Impact_of_Losing_Dental_Benefits.pdf

Access to routine preventive dental care is an important component of quality health care for all Americans.  Dental insurance coverage, especially for low income individuals, plays a crucial role in providing access to dental care.  This project provides objective estimates of the financial and social impacts of dental benefit reductions that can be used by decision makers in Oregon and other states, as well as at the national level, to help shape health policy discussions in a time of changing Medicaid programs nationwide.

This project employs secondary data analysis from two existing longitudinal studies to assess the impacts of dental coverage cuts.  Individual-level impacts are assessed using data from a prospective cohort study that has followed 2,783 OHP members from the time dental benefits were cut to the present. System-level impacts are assessed using an already-established database of Medicaid claims data spanning 18 months before and 16 months after the 2003 Medicaid program changes to study the extent to which cost savings associated with dental benefit reductions are offset by cost shifting to more expensive emergency room, inpatient, or emergency dental services. We 1) assessed differences in access to (and utilization of) dental care over time by comparing responses from the OHP Standard cohort (who lost dental coverage with the benefit changes) and OHP Plus members (who did not); 2) used multivariate analysis to assess differences between the groups, employing Rubin’s propensity score method to control for non-equivalence between OHP Plus and OHP Standard members; and 3) relative impacts of coverage loss on financial and health outcomes over time are assessed.