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Changes in Medicaid reimbursement have led to increased ER visits by adults to treat emergency dental problems

Poor and minority patients, who suffer from more dental problems than other groups, also are more likely to be insured by State Medicaid health plans than private plans. A change in Maryland's Medicaid policy a decade ago—which eliminated dentist reimbursement for adult emergency services, reducing payments to dentists from about $7.5 million to $0—seems to have increased the use of hospital emergency departments (EDs) to treat dental problems ranging from abscesses and cysts to periodontitis and broken teeth. However, more research is needed to determine the overall impact of this policy change on disadvantaged adults, notes Leonard A. Cohen, D.D.S., of the University of Maryland Dental School.

Dr. Cohen, Richard J. Manski, D.D.S., M.B.A., Ph.D., an AHRQ Dental Scholar-in-Residence, and their colleagues analyzed claims data from the Maryland Medicaid Management Information System (which included all Maryland hospitals). They compared patients' use of hospital EDs to treat mouth pain and infections associated with the teeth and periodontal tissues from February 16, 1991 through February 15, 1993 with such ED use after the Medicaid program change (February 16, 1993 through February 15, 1995). A total of 3,639 people visited EDs for treatment of dental problems sometime during the 4-year study period.

Results revealed 12 percent more ED dental-related claims in the postchange period than in the prechange period, after controlling for patient age, race, and sex. Higher rates of ED claims were seen for men, whites, and patients 21 through 44 years of age. Blacks had 13 percent fewer claims, and those aged 45-64 years and 65 years and older had 61 and 96 percent fewer claims, respectively. The magnitude of this increase nevertheless paled in comparison to the reduction in dentist-provided emergency services that resulted from the policy change and was not sufficient to substitute for the eliminated dentist-delivered services, conclude the authors.

See "Dental visits to hospital emergency departments by adults receiving Medicaid," by Dr. Cohen, Dr. Manski, Laurence S. Magder, Ph.D., and Daniel Mullins, Ph.D., in the June 2002 Journal of the American Dental Association 133, pp. 715-724.

Reprints (AHRQ Publication No. 02-R086) are available from the AHRQ Publications Clearinghouse.

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