Overview of Medicaid adult dental reimbursement and utilization

Comprehensive medical coverage is a mandatory benefit available to all Medicaid recipients nationwide, but dental benefits under Medicaid vary widely.

Each state’s Medicaid and/or Children’s Health Insurance Program guidelines provide mandatory comprehensive dental coverage for children, but there is no nationwide minimum requirement for dental coverage for adults. Adult dental benefits under Medicaid vary by state, ranging from no coverage to comprehensive coverage of all classes of service. Benefits within a state may also vary by Medicaid population. Certain subgroups may receive additional dental benefits or dental benefits different from other Medicaid recipients.

As an optional benefit, Medicaid adult dental benefits are subject to change with state budgets, leading to uneven dental coverage over time. Provider availability also limits access to dental coverage for the adult Medicaid population. Medicaid enrollees may face additional barriers to accessing dental care such as transportation to appointments and differences in language. The expansion of eligibility for Medicaid in many states thrust more adult beneficiaries into the system. In expansion states that offer adult dental benefits, an influx of newly insured beneficiaries may be seeking dental care.

In this paper, Milliman’s Joanne Fontana, Catherine Lewis, and Tory Carver explore the relationships among a state’s adult Medicaid dental benefit, provider reimbursement, and dental care utilization rates. They aim to shed light on the relationship between reimbursement and utilization in a dental program.

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