Dental Coverage for Medicaid Patients Won’t Eliminate Emergency Room Visits



More than 2 percent of emergency room visits could be easily avoided. That’s because that number is the amount of visits to the emergency room for problems that would be considered a nontraumatic dental condition.

The study was conducted by researchers at Stanford University, the University of California-San Francisco, Truven Health Analytics and the Federal Agency for Healthcare Research and Quality.

The expansion of Medicaid from the Affordable Care Act has made many low-income Americans eligible for dental coverage. The number is roughly 8.3 million, according to the American Dental Association. The problem is that many states don’t provide coverage for adults under Medicaid programs. And there isn’t often another option for Medicaid patients, since paying out of pocket is too costly.

From 2001 through 2008, emergency room visits for routine dental conditions like cavities, tooth pain and gingivitis rose by about 41 percent in the United States. Comparatively, overall emergency room visits only increased by about 13 percent.

Lack of dental coverage under Medicaid can be blamed in some cases. The dearth of dental offices in rural areas also was a factor, combined with some dentists that are unwilling to treat Medicaid patients.

The study explored county rates of emergency room visits for nontraumatic dental conditions in 29 states in 2010. The findings showed that there was a sufficient supply of dental providers in rural areas and that 90 percent of the emergency room visits came from urban areas.

This information indicates that patients have trouble finding dentists who accept Medicaid. The report showed that the amount of dentists who accept Medicaid was only 11 percent in Missouri, 15 percent in Florida and 20 percent in New York.

California and Washington reinstated nonemergency dental services after many states cut them around 2007. But many other states have yet to reinstate them. In 2012, fewer than half the states provided dental coverage to Medicaid patients who weren’t pregnant or disabled.

As of January 2013, about 45 million Americans lived in regions with a shortage of dental care providers, especially in rural areas. This problem likely won’t get better, since many dentists will most likely retire soon.

There are three ways to fix this overall problem, according to Maria Raven, MD, associate professor of emergency medicine at UCSF and the study’s senior author. The first would be to establish on-site dental clinics in emergency rooms. Secondly, increasing dental coverage using less-expensive telehealth and midlevel providers who aren’t dentists but can perform preventive and restorative care, such as fillings and minor extractions. The final thing would be to create incentives for payers and providers to offer or refer patients to preventive dental care, similar to what’s in place for colon and cervical cancer screenings.