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. Author manuscript; available in PMC: 2022 Jul 1.
Published in final edited form as: J Am Dent Assoc. 2021 Jul;152(7):551–559.e1. doi: 10.1016/j.adaj.2021.03.010

Medicaid Adult Dental Benefits and Oral Health of Low-Income Older Adults

Astha Singhal 1, Adeem Alofi 1,2, Raul I Garcia 1, Lindsay M Sabik 3
PMCID: PMC8330417  NIHMSID: NIHMS1714872  PMID: 34176569

Abstract

Background:

Older adults are keeping their natural teeth longer, spurring calls for dental coverage under Medicare. While Medicare dental coverage would benefit all older adults, the poorest among them are already eligible for dental benefits through Medicaid. We examine the association between states’ Medicaid adult dental benefits and dental utilization and tooth loss among low-income older adults.

Methods:

Using the BRFSS data from 2014, 2016 and 2018, we examined adults aged 65 years or more. The outcomes examined included annual dental visit, partial and complete tooth loss. Poisson regressions were used to obtain risk ratios after adjusting for covariates.

Results:

States’ Medicaid adult dental benefits were significantly associated with dental utilization, with low-income older adults in states with no coverage having the lowest probability of visiting a dentist (RR=0.83, 95%CI=0.74-0.94), followed by emergency-only coverage (RR=0.91, 95%CI=0.84-0.98), and limited benefits (RR=0.91, 95%CI=0.85-0.98) relative to states with extensive benefits. There were no significant differences in either partial or complete tooth loss.

Conclusions:

States’ Medicaid adult dental benefits are significantly associated with dental visits among low-income seniors. Providing comprehensive dental benefits under Medicaid can improve access to dental care among low-income older adults.

Practical Implications:

As the older adult patient population grows, the poorest older adults may face barriers to dental care in absence of dental coverage. Dental professionals must engage in advocating for comprehensive dental coverage, especially for vulnerable populations.

Introduction

Americans are aging, and the proportion of population that is 65 years and older is expected to outnumber children in the US as early as 2035.1 In the past, significant improvements were made in access to healthcare among children, achieving near universal coverage. While Medicare provides near-universal coverage for older adults, in contrast to other public coverage programs, it has high cost-sharing and excludes major categories of benefits such as dental. Preparing for the demographic shift underway requires a realignment of public health programs and policy priorities. This is especially true with regard to oral health, where we have made strides in children’s access and oral health outcomes, but have largely neglected adults and older adults.2

Older adults are especially vulnerable to dental diseases and have higher dental needs for several reasons. First, they are keeping their natural teeth longer than in the past, with more than 82.5% of older adults aged 65 or older having some natural teeth in 2009-2014 as compared to only 73.5% in 1999-2004.3 Second, older adults tend to have multiple chronic conditions and co-morbidities that can be a risk factor for poorer oral health and vice versa.4 Finally, many older adults typically lose employer-sponsored health and dental insurance upon retirement.5 While they qualify for Medicare when they turn 65, many older adults are not even aware that it does not cover any dental benefits.6

Access to regular and affordable dental care is essential to maintaining optimal oral health, which in turn affects one’s overall health and well-being.7,8 However, cost is the most significant barrier to accessing dental care, with significantly greater proportion of adults reporting cost barriers for dental care then for medical, prescription or long-term care.9 Financial barriers disproportionately affect low-income older adults, who are three times more likely to report affordability as a barrier and less than 25% of them visit a dentist in a given year.10 National data shows that partial and complete tooth loss are decreasing over time, but these gains are entirely made by higher-income older adults.3,11 In fact, the disparities in dental utilization and oral health outcomes based on income have been widening over the past several decades.3

There have been recent calls for Medicare to cover dental services, which would extend dental coverage to all older adults.12,13 However, this change requires congressional action and faces several political road blocks. About a third of all Medicare enrollees are enrolled in Medicare Advantage plans, that can sometimes supplement dental benefits with an increased premium. Recently, the proportion of Medicare Advantage plans that include dental benefits have been increasing with about 62% of all Advantage enrollees having some dental benefits.14 Among older adults, those with limited income and assets are most vulnerable and may qualify for Medicaid programs that supplement Medicare coverage and provide additional benefits (which vary by state). In fact, more than 7 million older adults are enrolled in Medicaid, comprising about 12% of all Medicaid enrollees.15 If all state Medicaid programs provided dental benefits for adults, it would extend coverage to many of the poorest older adults and potentially improve their access to dental care. However, no study thus far has examined the relationship of state Medicaid dental benefits with dental care use and oral health of low-income older adults. In this study, we examine the association of state Medicaid adult dental coverage with dental utilization and tooth loss among low-income older adults.

Methods

Data Source and Study Design

We used data from the 2014, 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS), which is a nationally representative annual survey that collects information on self-reported preventive health behaviors and risk behaviors. It is a telephone-based survey that is conducted at the state level, using a random, population-based sample of non-institutionalized adults. The BRFSS data is publicly available for all 50 states and Washington DC (also referred to as a state from here on). Oral health questions are included in even years only. We included data from three years to get more stable estimates and incorporate effects of within state policy changes.

Study Population

Our study population included all adults aged 65 years or more. We focused our primary regression analysis on the subset of ‘poor older adults’, defined as older adults with annual household income less than $15,000 for the purpose of this paper. Given that Medicaid eligibility for older adults in most states is between 75-100% FPL, 16 and the FPL was $12,140 for singles and $16,460 for couples in 2018,17 limiting our sample to older adults with incomes less than $15,000 threshold will capture most people who are income eligible for full Medicaid benefits.

Variables

We examined three outcome variables: dental visit in the past 12 months, loss of any permanent teeth, and loss of all natural teeth. Our main predictor variable was the extent of dental benefits covered by Medicaid for eligible adults. Based on this Medicaid policy, we categorized states into four groups for each study year as follows: no coverage for adult dental benefits, emergency-only coverage, limited coverage, and comprehensive coverage. Further details of coverage categories and individual states in each category can be found elsewhere.18

To address potential confounding between the predictor variable and the outcomes, our analyses accounted for other covariates that included: age, sex, household income, educational attainment, race-ethnicity, marital status, employment status and year. In addition, for the models with tooth loss as the outcome, we also adjusted for diabetes and smoking status, as they are known risk factors for tooth loss.19, 20

Analyses

Descriptive analyses included examination of three outcome variables: annual dental visit, any tooth loss and complete tooth loss, across income groups and levels of Medicaid adult dental benefits coverage. We used Poisson regression models to obtain risk ratios for having a) a dental visit in past 12 months b) any tooth loss and c) complete tooth loss by low-income older adults residing in states with none, emergency, limited or comprehensive dental benefits for Medicaid enrolled adults. Poisson regression were preferred over logistic regression because odds ratios can be biased with common outcomes, as was the case with tooth loss and dental visits.21 Poisson regression with robust variance estimator were used as it yields an unbiased prevalence ratio with non-rare binary outcomes.22 In addition to adjusting for potential confounders, we also used survey procedures to account for the complex sampling design of BRFSS.

Lastly, we conducted sensitivity analyses by only including states with stable Medicaid adult dental benefits level since 2014. This led to the exclusion of data from 11 states that had substantially changed their Medicaid adult dental benefits during the study period. We also examined the effect of adding state fixed effects to our model to account for time-invariant state characteristics.

Results

Among the 107 million Americans aged 65 and above represented by the BRFSS sample over three cycles, about 10% met our inclusion criteria of annual household income less than $15,000. Our sample of poor older adults included greater proportions of females, racial-ethnic minorities, individuals who were older, unmarried, unable to work and less educated than the overall population of older adults. Forty percent of poor older adults reported visiting the dentist within the last year, compared to 70% among non-poor older adults. Poor older adults had greater tooth loss, with 82% reporting the loss of at least one permanent tooth, and 29% reporting the loss of all natural teeth, compared to 70% and 12% among non-poor older adults, respectively (Table 1). These trends were consistent across levels of annual income. As income increased, the rate of annual dental visit also increases, while the rate of partial and complete tooth loss decreases (Figure 1). We found disparities in dental utilization and tooth loss across Medicaid adult dental benefit levels and other risk factors examined, but these disparities were more pronounced among poor older adults (Table 1).

Table 1.

Sample characteristics and percentage with annual dental visit, any tooth loss and complete tooth loss among poor (annual income less than $15,000) and non-poor older adults

NON-POOR OLDER ADULTS
N=313,509; Weighted N=96,694,466		 POOR OLDER ADULTS
N=33,050; Weighted N= 11,199,917
Sample
N		 Sample
%		 Annual
Dental
Visit
(%Yes)		 Any Tooth
Loss
(%Yes)		 Complete
Tooth Loss
(%Yes)		 Sample
N		 Sample
%		 Annual
Dental
Visit
(%Yes)		 Any
Tooth
Loss
(%Yes)		 Complete
Tooth Loss
(%Yes)
Dental Benefits * * * * * *
 None 15716 5.01 66.13 73.35 15.81 1759 5.32 32.30 88.22 35.65
 Emergency Only 103903 33.14 68.51 69.74 12.56 11589 35.07 39.00 80.79 28.00
 Limited 97120 30.98 69.74 71.15 13.46 10211 30.90 36.98 84.76 33.73
 Extensive 96770 30.87 72.90 67.97 10.15 9491 28.72 44.05 81.18 26.65
Sex * * **
 Males 138576 44.20 68.50 71.48 12.02 9233 27.94 37.74 81.85 27.87
 Females 174933 55.80 72.45 67.56 11.81 23817 72.06 41.80 82.26 29.53
Age Group * * * ** *
 65-69 years 108883 34.73 72.21 64.44 8.75 10251 31.02 40.91 81.47 24.27
 70-74 years 84298 26.89 70.86 69.63 11.84 7935 24.01 37.00 82.78 28.10
 75-79 years 56607 18.06 69.61 73.42 14.26 6163 18.65 40.14 81.51 32.39
 80+ years 63721 20.33 67.78 74.72 15.51 8701 26.33 43.32 82.83 33.10
Race-Ethnicity * * * * * *
 Non-Hispanic White 277436 88.49 72.42 68.14 11.75 23842 72.14 38.01 83.20 33.00
 Non-Hispanic Black 16932 5.40 55.99 83.14 17.57 4452 13.47 37.41 87.58 33.03
 Hispanic 6991 2.23 63.25 70.59 8.15 2533 7.66 46.48 75.23 15.84
 Non-Hispanic Others 12150 3.88 69.23 69.13 9.46 2223 6.73 49.11 81.47 26.62
Married * * * ** **
 Yes 169603 54.10 74.45 67.10 9.68 4169 12.61 44.40 80.46 24.48
 No 143906 45.90 64.59 73.07 15.26 28881 87.39 39.25 82.61 30.27
Employment * * * ** ** *
 For Wages 38016 12.13 74.47 64.78 7.60 990 3.00 45.26 77.28 18.64
 Self-employed 20465 6.53 74.85 61.79 6.28 731 2.21 42.91 70.77 15.77
 Unemployed 3049 0.97 53.60 72.19 15.01 872 2.64 43.16 77.06 17.67
 Others 12676 4.04 70.62 68.32 13.10 1817 5.50 43.85 78.43 27.41
 Retired 230873 73.64 70.81 70.44 12.30 22553 68.24 41.01 82.47 28.82
 Unable to Work 8430 2.69 45.52 81.78 28.12 6087 18.42 35.69 85.03 34.84
Education * * * * * *
 < High School 16642 5.31 43.33 82.13 28.53 8716 26.37 35.18 83.63 33.62
 High School/ GED 86839 27.70 63.03 77.25 16.65 13413 40.58 41.27 82.90 30.25
 1-3 years college 85567 27.29 72.14 70.20 9.92 7478 22.63 46.63 80.15 21.31
 4+ years college 124461 39.70 85.57 56.68 3.60 3443 10.42 54.87 72.92 11.77
Income Category
 <$15,000 N/A N/A N/A N/A N/A 33050 100.00 40.41 82.12 28.96
 ≥$15,000 313509 100.00 70.50 69.49 11.91 N/A N/A N/A N/A N/A
State expansion * * * ** **
 Yes 230142 73.41 71.84 68.81 11.20 22942 69.42 41.75 82.54 28.10
 No 83367 26.59 67.74 70.90 13.38 10108 30.58 37.98 81.89 30.51
Year ** * * **
 2014 102609 32.73 69.94 70.94 12.59 12107 36.63 38.90 82.44 28.37
 2016 111076 35.43 70.35 69.96 11.98 11480 34.74 39.38 81.77 30.52
 2018 99824 31.84 71.16 67.73 11.23 9463 28.63 42.97 82.14 28.05
Smoking * * * * * *
 Current smoker 25128 8.02 48.59 83.18 27.08 5514 16.68 26.24 86.76 42.74
 Former smoker 131671 42.00 69.43 74.12 14.39 12042 36.44 37.58 86.46 33.19
 Non smoker 156710 49.99 75.29 62.95 7.05 15494 46.88 46.76 77.62 21.73
Diabetes * * * ** ** **
 Yes 63424 20.23 62.46 76.59 16.25 9789 29.62 38.14 83.86 31.03
 No 250085 79.77 72.80 67.47 10.68 23261 70.38 41.51 81.28 27.95
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*

p <0.0001

**

p <0.05

figure 1:

figure 1:

Open in a new tab

Distribution of annual dental visit, any tooth loss, and complete tooth loss by annual household income

Results from our final adjusted models that included only poor older adults are presented in Table 2. The relationship between the state Medicaid adult dental benefits and dental care use among poor older adults follows a dose-response gradient. After adjusting for potential confounders, poor older adults residing in states with no adult dental benefits were least likely to have a dental visit within the last year (RR=0.83, 95% CI=0.74-0.94), followed by residents of states with emergency only dental benefits (RR=0.91, 95% CI=0.84-0.98), and limited dental benefits (RR=0.91, 95% CI=0.85-0.99), relative to residents of states with comprehensive adult dental benefits.

Table 2.

Adjusted risk ratios for annual dental visit, any tooth loss and complete tooth loss among poor older adults

Annual Dental
Visit* 		Any Tooth Loss** Complete Tooth
Loss**
Medicaid Dental Benefits RR 95% CI RR 95% CI RR 95% CI
None 0.83 0.74 0.94 1.03 1.00 1.07 1.02 0.91 1.15
Emergency 0.91 0.84 0.98 0.99 0.96 1.02 1.01 0.92 1.11
Limited 0.91 0.85 0.98 1.01 0.99 1.04 1.03 0.95 1.30
Extensive 1.00 1.00 1.00
Sex
Females 1.14 1.06 1.23 1.02 0.99 1.05 1.08 1.00 1.17
Males 1.00 1.00 1.00
Age Group 80+ 1.12 1.03 1.22 1.02 0.99 1.05 1.42 1.28 1.57
75-79 1.01 0.91 1.11 0.99 0.95 1.03 1.32 1.18 1.48
70-74 0.92 0.84 1.00 1.01 0.98 1.04 1.14 1.03 1.26
65-69 1.00 1.00 1.00
Race-Ethnicity Non-Hispanic Black 1.06 0.97 1.16 1.04 1.02 1.07 0.95 0.87 1.05
Hispanic 1.37 1.25 1.51 0.91 0.87 0.95 0.47 0.40 0.56
Non-Hispanic Others 1.24 1.07 1.43 1.01 0.95 1.07 0.95 0.78 1.14
Non-Hispanic White 1.00 1.00 1.00
Married
Yes 1.14 1.05 1.25 1.01 0.97 1.04 0.98 0.87 1.09
No 1.00 1.00 1.00
Employment For Wages 1.04 0.87 1.25 0.96 0.89 1.03 0.81 0.61 1.07
Self-employed 1.04 0.84 1.28 0.89 0.76 1.03 0.68 0.49 0.96
Unemployed 1.03 0.85 1.24 0.95 0.88 1.04 0.75 0.56 1.01
Unable to Work 0.92 0.83 1.01 1.02 0.98 1.05 1.19 1.08 1.30
Others 1.03 0.91 1.16 0.97 0.92 1.03 1.03 0.89 1.21
Retired 1.00 1.00 1.00
Education
4+ years college 1.67 1.51 1.86 0.87 0.82 0.91 0.34 0.28 0.42
1-3 years college 1.45 1.33 1.59 0.94 0.91 0.97 0.57 0.51 0.63
High School/GED 1.28 1.18 1.39 0.97 0.94 0.99 0.79 0.73 0.85
< High School 1.00 1.00 1.00
Smoking
Current smoker N/A N/A N/A 1.11 1.07 1.15 1.99 1.80 2.19
Former smoker N/A N/A N/A 1.11 1.08 1.14 1.50 1.37 1.63
Non smoker N/A N/A N/A 1.00 1.00
Diabetes
Yes N/A N/A N/A 1.03 1.01 1.06 1.17 1.08 1.26
No N/A N/A N/A 1.00 1.00
Year
2018 1.10 1.01 1.19 1.00 0.97 1.03 1.01 0.93 1.11
2016 1.01 0.94 1.09 0.99 0.96 1.02 1.07 0.99 1.17
2014 1.00 1.00 1.00
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*

adjusted for sex, age, race-ethnicity, marital status, employment, education and year.

**

adjusted for sex, age, race-ethnicity, marital status, employment, education, smoking, diabetes and year

When examining tooth loss, we found no significant differences in partial or complete tooth loss between poor older residents of states based on their Medicaid adult dental benefits after adjusting for the confounders (Table 2). All other covariates and risk factors showed expected results, except race-ethnicity. We found that after adjusting for covariates, Hispanics and non-Hispanic others (included Asians, multiracial, American Indian and Alaskan Native) were 37% and 24% more likely to have a dental visit in past year compared to non-Hispanic whites, respectively. Additionally, while non-Hispanic blacks were at greater risk of some tooth loss, Hispanics were almost 10% less likely to report any tooth loss and less than half as likely to report complete tooth loss, compared to non-Hispanic whites.

Sensitivity analysis by restricting the sample to states with stable Medicaid adult dental coverage level during the study period had no effect on our estimates, but revealed significant differences only between the states with no dental benefits relative to states with comprehensive benefits. Older adults in states with no dental benefits were significantly less likely to have a dental visit (RR=0.83, 95%CI:0.73-0.94) and more likely to report some tooth loss (RR=1.04, 95%CI:1.01-1.08) than those in states with comprehensive dental benefits (Results tabulated as a supplement). Adjusting for state fixed effects had minimal effect on our estimates of the relationship between Medicaid adult dental benefits and dental care use and tooth loss. However, after adding state-fixed effects to the model, our estimates became statistically non-significant.

Discussion

Our study provides timely evidence using recent nationally representative state-level data on the relationship between states’ Medicaid adult dental coverage and dental utilization and tooth loss among poor older adults. Our results suggest that comprehensive Medicaid adult dental benefits are significantly associated with increased dental utilization among the most vulnerable older adults. Previous studies have demonstrated that Medicaid dental benefits are associated with increased dental care use, but all of these studies examined poor working-aged adults.20,21 Our study is the first to provide evidence on the impact of Medicaid dental benefits and dental care use by poor older adults.

When examining tooth loss, we did not find any significant differences in either partial or complete tooth loss among poor older adults residing in states with different levels of Medicaid adult dental benefits. These results were not entirely unexpected because tooth loss is an adverse outcome resulting from the culmination of a series of complications that arise due to foregone dental care. It is a distal outcome that was not found to be linked with the concurrent dental benefits coverage, except between the extreme categories of dental benefits. Regardless, we examined tooth loss as it has significant negative implications for older adults including poor nutritional status, cognitive impairment and lower quality of life. 22,23

Interestingly, we found that poor older adults who were Hispanics, and to a lesser extent, non-Hispanic others, were significantly more likely to have a dental visit in the past year, compared to non-Hispanic whites. Moreover, Hispanics were much less likely to report any or complete tooth loss, relative to non-Hispanic whites. These findings were not expected, given previous studies that have reported on poor oral health status and lower dental care use by Hispanics.24,25,26 Both Hispanics and non-Hispanic others are comprised of heterogeneous subgroups with distinct characteristics. In our study, non-Hispanic others included disparate groups of Asians, American Indian and Alaskan Native and multiple racial groups. The Hispanic paradox is well-documented in health outcomes literature, but has not been adequately explored with oral health outcomes.27 It refers to an unexpected, unexplained advantage among Hispanics over non-Hispanic whites, primarily in mortality and longevity, after adjusting for other risk factors.28 However, a positive effect of Hispanic ethnicity on dental visitation and tooth loss is unexpected because, in addition to socio-economic challenges, they also face language and cultural competence barriers when seeking dental care compared to non-Hispanic whites. Some studies suggest that variations in immigrant status, nativity, acculturation, language preference and other cultural factors amongst Hispanics may be associated with dental use and oral health outcomes.27,29 Whilst racial-ethnic differences were not the primary focus of our study, these are intriguing results that warrant future research to understand this phenomenon further.

Sensitivity analyses showed that our estimates were largely robust to variations in analytic approach. When restricting our analyses to states that didn’t change their dental benefits during the study, we found essentially similar results but only the differences between two extreme categories of benefits remained statistically significant. Similarly, when we included state fixed effect to account for time-invariant state-specific characteristics, the associations maintained the same direction but became statistically insignificant. In our study, since most states’ Medicaid dental benefits stayed constant during the study period, adding state fixed effects may also be adjusting for these time-invariant dental benefits, hence rendering the main effects non-significant. However, it is also possible that Medicaid dental benefits may be correlated with other state-specific factors, such as dentist supply, reimbursement rates etc., that impact access to dental care. Future studies should use longitudinal data to examine the effect of within-state changes in dental benefits on dental utilization and oral health of low-income older adults to separate the effect of dental benefits from other state-specific characteristics.

There were some limitations to our study. First, as with any survey data, there is possibility of over- or under-reporting of outcomes. However, we do not anticipate that such reporting bias would systematically differ between the groups of states or over time. Second, states’ Medicaid dental coverage policy would only apply to Medicaid enrollees. We used annual household income less than $15,000 as a surrogate for Medicaid eligibility as BRFSS does not collect comprehensive information on insurance coverage and has a large number of missing values for the health insurance variable. Moreover, focusing on older adults who are likely to be eligible for Medicaid yields a more consistent population across states and avoids concerns regarding selection into Medicaid coverage that would arise if we limited our sample to individuals actually enrolled. Third, often partial and complete tooth loss are longer-term outcomes of dental disease and forgone dental care, and may not be sensitive outcomes when examining concurrent dental coverage policy. Intermediate outcomes such as untreated dental decay, dental pain and unmet dental need might be more appropriate and sensitive outcome measures but were not available in the data source. Finally, many Medicare Advantage plans do offer supplemental dental coverage.30 However, Medicare Advantage plan enrollment information was not available in BRFSS, which may confound our results.

We know that older adults are an expanding demographic and they are keeping natural teeth longer, fueling a greater need for dental care among older adults.2,3,26 Currently, there are efforts such as proposed legislative reforms to include dental care coverage in Medicare to improve dental care and oral health of older adults.31,32 These proposals, if passed, would allow all older adults to have dental coverage. However, such reforms are fraught with political divisiveness and their feasibility would largely depend on the political landscape moving forward. In addition, the cost estimates of covering dental benefits under Medicare are highly variable. While some studies argue the potential for cost savings downstream,33 others peg the estimate between 13 to 16 billion US dollars per year, depending on the premium amount, treatment costs covered and how the dental benefits would be structured.13 Moreover, data shows that older adults who are non-users of dental care tend to be sicker, low-income, less educated and belong to racial-ethnic minority groups and more likely to need extensive, specialized and expensive dental care.34,35 This makes it likely that the actual costs of expanding dental benefits would be greater than those modeled after current users of dental care. The political hurdles that have kept dental benefit inclusion in Medicare from becoming a law thus far, and the substantial price tag of such a benefit inclusion, make the prospects for this option fairly grim.

Our results provide evidence for an alternative approach to improve access to dental care and improve oral health for the most vulnerable older adults. We know from literature that low-income older adults have higher dental disease burden and very limited resources to access dental care, and these income-based disparities are worsening over time.11 By requiring Medicaid to provide a comprehensive mix of dental services for adults, we could improve dental utilization and oral health of not only low-income older adults, but all low-income adults covered by the Medicaid program. The ADA estimates that providing an extensive dental benefit for adults under Medicaid would cost $1.4 to $3 billion per year, based on an analyses from 22 states that currently do not provide dental benefits.36 While such expansion of dental coverage may not be cost-saving, the costs would be partially offset by savings in emergency department visits for dental problems and perhaps, lower medical care expenses and improved employability outlook.37,38

Public Health Implications

As Americans age, we need to examine and realign public health policies and programs to meet their needs. Older adults have high dental care needs and there have been discussions about adding a dental benefit in Medicare. However, given the political and economic hurdles that diminish the outlook for provision of dental benefits under Medicare, our study adds another dimension to this ongoing policy debate. While a Medicare dental benefit would possibly improve access to dental care for all older adults, our results indicate that mandating adult dental benefits under Medicaid could improve access and oral health outcomes for those most in need, the poorest older adults.

Supplementary Material

Appendix with sensitivity analyses

Funding Disclosure:

Research reported in this manuscript was supported by National Institute of Dental and Craniofacial Research, of the NIH under a career development award number 5K08DE027720

Footnotes

Conflict of Interest: None of the authors have any conflicts to report

References

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Appendix with sensitivity analyses
NIHMS1714872-supplement-Appendix_with_sensitivity_analyses.docx (18.8KB, docx)

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