Impact of Medicaid Dental Coverage Expansion on Dental Care Utilization and Behavioral Responses Among Reproductive-Age Women

• In Event: Impacts of Medicaid Dental Benefits Among Pregnant People, Reproductive-Age Women, and Other Adults

Abstract

Dental care utilization among reproductive-age women can affect not only their oral and overall health but also influence other health behaviors, with potential long-term intergenerational implications. This paper examines the effects of Medicaid dental coverage expansion for non-pregnant adults on dental care utilization and behavioral outcomes among reproductive-age women (21–44 years old), using data from the comprehensive Behavioral Risk Factor Surveillance System (BRFSS) spanning 2000 to 2022. We define dental benefits treatment states as those offering more than just emergency extractions or pain relief, including restorative and preventive care for non-pregnant adults. 

Leveraging variations in time and state policies for adding or dropping dental care benefits, our identification strategies incorporate both triple-difference and difference-in-differences approaches. In the first stage, we estimate changes in the likelihood of dental care utilization following the addition of dental care benefits among Medicaid-eligible reproductive-age women. Our results indicate that expanding non-pregnant dental benefits increases the likelihood of using dental care in the most recent 12 months by an average of 5 percentage points, a 8.6% increase from a base rate of 56% among eligible reproductive-age women. Given that approximately 42% of Medicaid enrollees in the BRFSS data are identified as Medicaid-eligible based on reported household income intervals and state-specific eligibility thresholds, the magnitude translates to nearly a 11-percentage-point increase, representing a 20% rise relative to the sample mean likelihood of dental care utilization. 

While increased preventive dental care utilization might encourage healthier habits, expanded coverage could also lead to adverse health behaviors due to moral hazard. To explore this possibility, we investigate the impact of Medicaid dental care expansion on smoking behaviors, which are closely linked to oral health. Our findings provide evidence of potential moral hazard: women eligible for expanded dental benefits show higher probabilities of becoming new smokers and frequent smokers. 

These findings highlight the dual impact of Medicaid dental coverage expansion—improving access to oral healthcare while potentially influencing related health behaviors. Our results remain robust across various samples and methodologies. These include restricting the analysis to pre-COVID years, excluding states that have ever dropped dental care coverage or experienced multiple changes, excluding states that already had expanded dental benefits, using different Medicaid eligibility calculation methods, and employing various analytical approaches, such as TWFE and two-stage difference-in-differences. The study underscores the importance of policymakers considering both the direct and indirect effects of public health insurance programs to maximize their overall effectiveness.

Author

• Xuechao (Jane) Qian, Ball State University
  Presenting Author