Spillover Effects of Medicaid Dental Coverage Expansions on Health Status

项目摘要/摘要 从历史上看，美国低收入成年人的牙齿健康状况和总体状况都较差 与收入较高的人相比，他们的健康状况更差，获得牙科和医疗服务的机会也更少。 口腔健康是整体健康和幸福的关键组成部分。然而，这些关系 口腔健康和整体健康之间是双向的，受几个因素的影响。 鉴于这些复杂的关系，有必要对因果影响进行证据检验 关于获得牙科服务的变化对整体健康状况的影响。我们将作出重大贡献 通过利用牙科覆盖面最近的外部变化来填补这一知识缺口，并 由于平价医疗法案(ACA)医疗补助的自然扩大，牙科服务的使用 研究牙科服务使用对整体健康状况的影响的实验。截至2019年，33个州 将医疗补助的资格扩大到所有低于联邦贫困水平138%的非老年成年人。 然而，成人的医疗补助牙科保险在各州是可选的，因此，有 随着时间的推移，各州的牙科覆盖率存在显著差异。此变体提供了一种 了解牙科覆盖范围和服务使用的溢出效应的独特机会 整体健康状况。ACA医疗补助计划扩大了牙科福利，增加了牙科 就诊和使用预防和治疗牙科服务，但效果不同于 牙科福利。这一证据表明，医疗补助计划的扩张及其在 牙科福利提供了一个独特的机会来了解访问 牙科服务和整体健康状况。利用自然实验和现有的 来自两个具有全国代表性的调查的数据，我们将提供关于 最近为低收入成年人提供牙科福利的医疗补助计划扩大了对他们整体健康的影响 从第一次扩张开始，超过7年的状况。我们将按州来检验效应的异质性 与L相关的牙科覆盖范围、牙医供应和人口统计学变量的慷慨程度 健康状况、口腔健康和牙科服务使用情况。从这项研究中得出的证据是 与准确评估口腔健康计划的有效性和成本效益有关 并通过考虑对整体健康的溢出效益来制定政策。证据也将是 对全国和各州的医疗补助政策都很有用。调查结果也将为讨论提供信息 政策制定者和利益相关者关于为老年人提供医疗保险中的牙科保险 成人和雇主赞助或独立购买的计划。这项研究还将 使用其他数据源(如索赔数据)评估更改，从而推动更大规模的研究 在牙科和医疗保健中使用准实验设计进行个体层面的使用。

PROJECT SUMMARY/ABSTRACT Low-income adults in the United States have historically had worse dental health and overall health status than higher income individuals and less access to dental and medical services. Oral health is a key component of overall health and wellbeing. However, the relationships between oral health and overall health are bi-directional and subject to several confounders. Given these complex relationships, there is a need for evidence examining the causal impacts of changes in access to dental services on overall health status. We will contribute substantially to filling this knowledge gap by leveraging recent exogenous changes in dental coverage and dental services use due to the Affordable Care Act (ACA) Medicaid expansions as a natural experiment to study effects of dental services use on overall health status. As of 2019, 33 states expanded Medicaid eligibility to all non-elderly adults below 138% of the federal poverty level. However, Medicaid dental coverage for adults is optional for states, and as a result, there is significant variation in dental coverage across states and over time. This variation provides a unique opportunity to understand the spillover effects of dental coverage and services use on overall health status. The ACA Medicaid expansions with dental benefits have increased dental visits and use of preventive and treatment dental services but effects differed by generosity of dental benefits. That evidence demonstrates that the Medicaid expansions with their variation in dental benefits provide a unique opportunity to understand connections between access to dental services and overall health status. Taking advantage of a natural experiment and existing data from two nationally representative surveys, we will provide the first evidence on effects of the recent Medicaid expansions with dental benefits for low-income adults on their overall health status over 7 years from the first expansions. We will examine heterogeneity in effects by state generosity of dental coverage, dentist supply, and demographic variables associated with l health status, oral health and dental services use. The evidence from the study is highly relevant for accurate evaluations of the effectiveness and cost-benefit of oral health programs and policies by accounting for spillover benefits to overall health. The evidence will also be useful for Medicaid policies both nationally and for states. Findings will also inform discussions among policymakers and stakeholders about offering dental coverage in Medicare for older adults and in employer-sponsored or independently purchased plans. The study will also motivate larger scale studies using other data sources such as claims data to assess changes in dental and medical care use at the individual-level using quasi-experimental designs.