The role of comprehensive adult Medicaid dental benefit in improving oral health and reducing disparities among adults and children

成人综合医疗补助牙科福利在改善口腔健康和减少口腔疾病中的作用 成人与儿童之间的差异 项目摘要 尽管口腔健康对整体健康、经济生产力和健康都是不可或缺的，这一点已得到公认。 因此，它仍然是美国最常见的未得到满足的健康需求。低收入和少数群体携带着 牙病负担极高，突出了社会经济差距和缺乏口腔治疗的机会 医疗保健。这些群体中有很大一部分依赖医疗补助，但与儿童不同的是，联邦法律不 强制为成年人提供牙科保险，保险范围因州而异，导致许多人没有保险或保险不足。 从2021年7月开始，弗吉尼亚州扩大了所有参加医疗补助的成年人的牙科覆盖范围(高达FPL的138%)， 首次向数以千计的成年人提供全面的牙科保健。这份牙科保单 改变提供了一个独特的机会，一种“自然的实验”，让我们更深入、更清晰地了解 实施牙科综合福利对医疗补助参保人口腔健康的影响 口腔健康服务研究方面的差距。建议的K08研究项目的目的是评估其作用 弗吉尼亚州关于牙科保健利用和减少口腔健康的综合成人医疗补助牙科政策 医疗补助人群之间的差距。该项目将：1)研究以下人群对牙科服务的需求： 在牙科福利实施后参加医疗补助的成年人，2)评估牙科的影响 通过比较参加医疗补助的成年人，获得利用急诊科(ED)进行牙科就诊的好处 以及3)评估医疗补助成人牙科福利对儿童的影响 牙科护理用途。数据来源将包括弗吉尼亚州医疗补助计划的多年索赔数据和 弗吉尼亚州所有付款人的索赔数据将与县级劳动力和社区数据相关联 来自多方面的社会因素。因果推理方法与高级计量经济学和数据科学 将使用差分和中断时间序列等方法来分离策略的 对测量的口腔健康结果的影响。此K08应用程序的主要目标是推进 候选人(纳瓦尔博士)的研究生涯，通过保护她获得卫生政策培训的时间， 计量经济学和数据科学，并获得研究经验，应用这些方法进行严格的 口腔健康服务和健康政策研究。这一目标将通过执行建议的 在精心规划的培训目标和密集的职业发展活动的支持下进行研究。这个 拟议的研究成果将产生必要的证据，为加强现有和 新政策，包括为最大限度地减少差距和最大限度地增加口腔健康所需的系统层面的改变。 多学科指导和咨询团队的专业知识和指导，以及 通过体制环境提供的资源和对培训的承诺将确保成功 候选人的研究项目，并使她能够作为一个独立的 研究调查员。

The Role of Comprehensive Adult Medicaid Dental Benefit in Improving Oral Health and Reducing Disparities among Adults and Children Project Summary Even though it is well established that oral health is integral to overall health, economic productivity, and well- being, it remains the most common unmet health need in the US. Low-income and minority groups carry a significantly high burden of dental disease, highlighting socioeconomic disparities and lack of access to oral health care. A large proportion of these groups rely on Medicaid, but unlike children, federal law does not mandate dental coverage for adults, and coverage varies by state leaving many uninsured or underinsured. Starting July 2021, Virginia expanded dental coverage for all Medicaid-enrolled adults (up to 138% of FPL), providing access to comprehensive dental care to thousands of adults for the first time. This dental policy change provides a unique opportunity, a 'natural experiment,' to gain a deeper and clear understanding of the effect of implementing a comprehensive dental benefit on the oral health of Medicaid enrollees and fill a critical gap in oral health services research. The purpose of the proposed K08 research project is to evaluate the role of Virginia's comprehensive adult Medicaid dental policy on dental care utilization and reducing oral health disparities among the Medicaid population. The project will: 1) examine the demand for dental services among Medicaid-enrolled adults following the implementation of the dental benefit, 2) evaluate the impact of dental benefit on the use of the emergency department (ED) for dental visits by comparing adults enrolled in Medicaid with those having private insurance, and 3) assess the effect of the Medicaid adult dental benefit on children's dental care use. Data sources will include multi-year claims data from the Virginia Medicaid program and Virginia All Payers Claims Data that will be linked with the county-level workforce and community data on social factors from multiple sources. Causal inference methods and advanced econometric and data science approaches such as difference-in-difference and interrupted time series will be used to isolate the policy's effect on measured oral health outcomes. The primary goal of this K08 application is to advance the candidate's (Dr. Naavaal) research career by protecting her time to acquire training in health policy, econometrics, and data science and gain research experience in applying these methods to conduct rigorous oral health services and health policy research. This goal will be accomplished through executing proposed research supported by carefully planned training objectives and intensive career development activities. The proposed research outcomes will generate the evidence needed to inform strategies to strengthen existing and new policies, including systems-level changes needed to minimize disparities and maximize oral health gains. The expertise and guidance of the multi-disciplinary mentoring and advisory teams, in addition to the wealth of resources and commitment to training provided through the institutional environment, will ensure the success of the candidate's research project and enable her to establish a robust research program as an independent research investigator.