Fluctuating State Medicaid Dental Coverage: Asymmetric Impact Of Benefit Cuts And Expansions, 2010–21

Medicaid adult dental coverage is an optional benefit that states often add or remove in response to budgetary pressures. The effect of these fluctuations on access to dental services is unclear. Using 2010-21 Health and Retirement Study data and a dynamic difference-in-differences event study, we examined the effects of removing versus adding Medicaid adult dental benefits among adults ages 50-64 with income up to 100 percent of the federal poverty level. Eliminating benefits was associated with increased dental uninsurance (60.1 percentage points) and any out-of-pocket spending in the past two years (20.2 percentage points), as well as decreased dental visits in the past two years (-37.4 percentage points) and edentulism (complete loss of all natural teeth; -13.4 percentage points). Expanding benefits was associated with decreased dental uninsurance (-40.7 percentage points) and any out-of-pocket spending (-36.5 percentage points), as well as increased dental visits (22.1 percentage points) and edentulism (16.9 percentage points). Both changes were associated with increased unawareness of dental coverage (11.7 and 33.0 percentage points, respectively). Several effects persisted up to eight years, indicating that Medicaid dental policy shifts have lasting implications. These findings underscore the importance of stable Medicaid dental coverage, particularly as Congress and states weigh large-scale Medicaid cuts.