Even With Insurance, Medicaid Recipients Still Go to ER for Dental Problems

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States that provide Medicaid adult dental care still have high rates of dental patients who show up at hospital emergency departments, particularly in urban underserved areas, according to a study released this week. The study -- by researchers at Stanford University, UC San Francisco, Truven Health Analytics and the federal Agency for Healthcare Research and Quality -- was published in Health Affairs.

Researchers said a dearth of dental providers who accept Medicaid patients, particularly in those urban underserved areas, has limited the effectiveness of Medicaid dental coverage in states that provide it.

"We found that, in urban counties there were large concentrations of all providers, but not really to serve the poor," said Maria Raven, senior author of the study and associate professor of emergency medicine at UCSF.

"There may be a higher density of dentists [in urban areas], but they're still not accepting Medi-Cal patients," Raven said. "Coverage doesn't equal access."

That has resulted in high ED use even in states with Medicaid dental coverage, she said.

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Medi-Cal is California's Medicaid program, and it did not have adult dental coverage in 2010, when the study's data were collected.

Katie Fingar, lead author of the study and research leader in health care at Truven, said the numbers were slightly better in rural areas.

"We did see that for those in rural areas, a greater supply [of dental providers] was associated with lower ED use," Fingar said. But, she said, 90 percent of Medicaid dental visits are in urban areas.

As a result, she said, more than 2 percent of all emergency department visits are related to non-traumatic dental conditions.

In April, the American Dental Association released a similar study that drew similar conclusions.

"One of the important things about the study we did is we looked at provider density," Raven said. "People say there are plenty of dentists, but there's a subtler argument we're trying to make, that there is a low rate of dentists who take Medicaid."

Provider rates in California are among the lowest Medicaid rates in the nation, she said, but care can still be worked out in underserved urban areas, such as the use of mid-level dental providers -- or getting more dentists to see Medi-Cal patients.

"It's too bad provider rates aren't higher," she said, "but everyone needs to pitch in. Coverage is a necessity, but you have to pair it with providers."

David Gorn is a senior reporter with California Healthline.