BACKGROUND: As of December 2015, 67,000 more adults under age 65 obtained dental coverage through RI Medicaid, a 78% increase after implementation of the ACA. This report will assess ED utilization related to non-traumatic oral/dental diagnoses, associated with RI Medicaid expansion.
METHODS: RI hospitals are required to submit hospital ED encounter data to the RI Department of Health pursuant to their licensure authority. Data extracted and analyzed for this report were adult (age 21-64 years) ED visits that did not result in hospital admission during 2012-2015. Consistent with measures and ICD-9-CM codes utilized in 2014 National Healthcare Quality and Disparities Report (Agency for Healthcare Research and Quality), this study included ED visits related to non-traumatic oral/dental diagnoses, asthma, mental health, and alcohol/substance abuse that are preventable with coordinated and adequate access to primary dental or medical care. ED visits were assessed by year, payor and age (SAS® v9.4), and rates among RI adults were calculated using total number of Medicaid enrollees and census data for corresponding study periods.
RESULTS: The proportion of ED encounters with non-traumatic oral/dental diagnosis was statistically unchanged in 2014-15 (2.5%) compared to 2012-13 (2.7%). However, since 2014, Medicaid was reported as the most common payment source for all ED visits included in this study. For oral/dental diagnoses, hospital charges to Medicaid increased by 57%; this increase was greater than ED visits related to alcohol/substance abuse (48%), asthma (44%), and mental illness (39%). Oral/dental complaints were 5 times more frequent among Medicaid-enrolled versus non-Medicaid-enrolled adults (26 vs. 5 per 1,000 adults). Disparity by Medicaid coverage status is wider in ED visits with oral/dental conditions than other ED visits: 3.5 times for alcohol/substance abuse (52 vs. 15 per 1000 adults), 3 times for asthma (9 vs. 3 per 1000 adults), and 2.5 times for mental illness (37 vs. 15 per 1000 adults).
CONCLUSIONS: High ED utilization among Medicaid adults was persistent across the study periods before and after ACA implementation. Attributed to Medicaid expansion after the ACA and inadequate access to dental services for Medicaid enrollees, ED uses with oral/dental conditions increased healthcare spending and fiscal pressure to the state. The majority of non-traumatic oral/dental complaints in ED can be prevented given access to preventive and regular oral healthcare. Public health programs and policies should provide better accessible dental services for Medicaid enrollees and improve education to increase awareness of dental benefits and receipt of effective and regular oral healthcare.