Effects of a Medicaid dental coverage "cliff" on dental care access among low-income Medicare beneficiaries.
Effects of a Medicaid dental coverage "cliff" on dental care access among low-income Medicare beneficiaries.
复制标题
医疗补助牙科保险覆盖“悬崖”对低收入医疗保险受益人获得牙科护理的影响。
DOI：
10.1111/1475-6773.13981
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发表时间：
2023
影响因子：
3.4
通讯作者：
Sabik,LindsayM
中科院分区：
文献类型：
--
作者：
Roberts,EricT;Mellor,JenniferM;McInerny,MelissaP;Sabik,LindsayM
目的评估医疗补助牙科保险的突然下降或“悬崖”如何影响低收入医疗保险受益人获得牙科护理。医疗补助是低收入医疗保险受益人牙科保险的重要来源，但收入略高于医疗补助资格门槛的受益人的牙科保险选择较少，导致牙科覆盖率超过这些阈值。数据来源医疗保险当前受益人调查（MCBS）研究设计我们使用了回归不连续设计来评估这种牙齿覆盖率悬崖的影响。这项研究设计利用了医疗补助计划中老年人和残疾人收入资格阈值以上的医疗补助覆盖率的突然差异。数据收集该研究包括在MCBS中接受调查的低收入社区居住医疗保险受益人，其收入（以联邦贫困水平的百分比测量）在州特定医疗补助收入资格阈值的±75个百分点内（n= 7508受访者年，加权后代表26，776，719受益人年）。主要发现收入超过医疗补助资格门槛的医疗保险受益人报告由于成本问题或缺乏保险而难以获得牙科护理的可能性比低于门槛的受益人高5.0个百分点（95%CI：0.2，9.8;p= 0.04）-三分之一的比例增加报告困难低于阈值（15.0%）.ConclusionsA Medicaid牙科覆盖悬崖加剧了低收入医疗保险受益人获得牙科保健的障碍。扩大医疗保险受益人的牙科保险，特别是那些没有资格享受医疗补助的人，可以减轻由于医疗保险中缺乏全面的牙科保险而导致的牙科保健障碍。
ObjectiveTo evaluate how an abrupt drop‐off, or “cliff,” in Medicaid dental coverage affects access to dental care among low‐income Medicare beneficiaries. Medicaid is an important source of dental insurance for low‐income Medicare beneficiaries, but beneficiaries whose incomes slightly exceed eligibility thresholds for Medicaid have fewer affordable options for dental coverage, resulting in a dental coverage cliff above these thresholds.Data SourceMedicare Current Beneficiary Surveys (MCBS) from 2016 to 2019.Study DesignWe used a regression discontinuity design to evaluate effects of this dental coverage cliff. This study design exploited an abrupt difference in Medicaid coverage above income eligibility thresholds in the Medicaid program for elderly and disabled populations.Data CollectionThe study included low‐income community‐dwelling Medicare beneficiaries surveyed in the MCBS whose incomes, measured in percentage points of the federal poverty level, were within ±75 percentage points of state‐specific Medicaid income eligibility thresholds (n= 7508 respondent‐years, which when weighted represented 26,776,719 beneficiary‐years).Principal FindingsMedicare beneficiaries whose income exceeded Medicaid eligibility thresholds were 5.0 percentage points more likely to report difficulty accessing dental care due to cost concerns or a lack of insurance than beneficiaries below the thresholds (95% CI: 0.2, 9.8;p= 0.04)—a one‐third increase over the proportion reporting difficulty below the thresholds (15.0%).ConclusionsA Medicaid dental coverage cliff exacerbates barriers to dental care access among low‐income Medicare beneficiaries. Expanding dental coverage for Medicare beneficiaries, particularly those who are ineligible for Medicaid, could alleviate barriers to dental care access that result from the lack of comprehensive dental coverage in Medicare.