Closing the Prenatal Dental Gap: Evidence from Medicaid Pregnancy Dental Benefit Expansions

• In Event: Reproductive Health

Abstract

Oral health during pregnancy is linked to adverse birth outcomes, including preterm birth and low birthweight, yet dental care utilization among pregnant Medicaid enrollees remains persistently low. Despite the clinical importance of prenatal dental care, many states do not provide comprehensive dental benefits to pregnant Medicaid enrollees, and women who qualify for Medicaid solely due to pregnancy often face particularly limited coverage. While several states have expanded Medicaid dental benefits specifically for pregnant women in recent years, rigorous causal evidence on the impact of these expansions on utilization remains limited. Using the T-MSIS Analytic Files from 2015 to 2022, covering Medicaid-enrolled deliveries across all 50 states, we estimate the effect of state pregnancy dental benefit expansions on dental care utilization during pregnancy. We identify pregnant Medicaid enrollees using hospital discharge and outpatient records and measure dental utilization outcomes including any dental visit, preventive care (cleaning, exam, and fluoride application), and restorative treatment (filling, extraction, root canal, and periodontal care). We employ a staggered difference-in-differences design using the Callaway-Sant'Anna estimator to account for heterogeneous treatment timing across adopting states, with event-study specifications to assess pre-trends and dynamic treatment effects. In preliminary estimates, pregnancy dental benefit expansions increased the probability of any dental visit and preventive cleaning visits by approximately 30 percent, suggesting that coverage expansions meaningfully shift utilization among pregnant Medicaid enrollees. Ongoing work will examine heterogeneity by county-level dentist supply, testing whether supply-side constraints attenuate the effectiveness of coverage expansions, and by beneficiary eligibility type, distinguishing women with full-scope Medicaid from those with pregnancy-only coverage for whom dental benefits were newly available. We will further examine whether effects differ for women who were already enrolled in adult Medicaid prior to pregnancy and thus may have had prior access to dental benefits, relative to those who gained Medicaid coverage exclusively through pregnancy. We will also assess whether utilization gains are sustained over the post-expansion period or concentrated immediately following policy adoption.

Author

• Anwar Assamidanov, University of California, Irvine
  Presenting Author