Field Experiment to Assess the Impact of Medicaid on Disparities in Dental Care Utilization

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PROJECT SUMMARY/ABSTRACT An estimated 9.8 million adults have gained oral health insurance since the implementation of the Affordable Care Act (ACA). However, utilization of dental services among disadvantaged groups remains low, resulting in the stubborn persistence of oral health disparities. These findings suggest that there are persistent barriers to oral health care beyond just coverage alone. According to the Andersen model of healthcare utilization, oral healthcare utilization is driven by enabling factors (such as insurance access) as well as predisposing factors (such as oral health literacy). Hence, it is critical to identify the bottlenecks in boosting the uptake of oral healthcare services, thereby improving the oral health status of minority and low-income Americans. Our overall objective is to assess whether the availability of dental providers poses a barrier to accessing dental care among low-income and minority adults. We propose to conduct a field experiment to simulate the experiences of patients with Medicaid coverage in obtaining dental appointments. Our design takes into account state variations in Medicaid policies and neighborhood characteristics, thus enabling us to examine the extent to which underlying structural factors contribute to disparities in access to dental care. Our specific aims are: 1) To examine the geospatial distribution of dental providers according to neighborhood characteristics; 2) To identify the association between Medicaid insurance status and availability of dental appointments; and 3) To assess the cross-level interaction between structural barriers (state Medicaid dental policy and neighborhood characteristics) and availability of dental appointments among Medicaid beneficiaries. Findings from this study, using a robust experimental approach and primary data collection, will provide direct and objective measures of access to dental care to guide states in implementing effective policies to reduce disparities in oral health.