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Agency for Healthcare Research Quality

Health Care Costs and Financing

Maryland Medicaid saved millions of dollars by ending reimbursement of dentists for treating adult dental emergencies

The Maryland Medicaid program eliminated reimbursement to dentists, but not to physicians or hospitals, for treating adult dental emergencies in 1993. By 1995, 2 years after this change in reimbursement, Medicaid costs for adult dental care claims plunged to zero from more than $7.5 million in the 2 years preceding the change. Medicaid reimbursement for routine adult dental services was eliminated by the State in 1976.

Surprisingly, Medicaid costs for emergency dental care for adults also dropped significantly in every other care setting, generating an additional $232,470 savings during the post-change period (1993-1995). For instance, emergency department (ED) costs for dental emergencies dropped 10 percent from $723,835 to $651,649, even though the number of ED claims rose from 2,081 in the pre-change period to 2,245 in the post-change period. The largest drop in costs was seen in physician-linked ED claims, which dropped nearly 69 percent from the pre-change to the post-change phase. Thus, Medicaid's goal to reduce dental costs was achieved but perhaps at a price, suggests Richard J. Manski, D.D.S., M.B.A., Ph.D., Dental Scholar-in-Residence at the Agency for Healthcare Research and Quality.

Dr. Manski and his colleagues point out that disadvantaged patients may have been confused by the policy change, perhaps believing that Medicaid would not cover any care for dental emergencies. They likely suffered poorer health outcomes and paid for emergency dental treatment out of pocket, found free clinics, or received free care from generous dentists. These findings are based on analysis of Maryland Medicaid data on ED and other provider claims by adult Medicaid patients for the treatment of mouth pain and infections associated with the teeth and periodontal tissues during the 4-year period from February 16, 1991 to February 15, 1995.

See "Medicaid coverage and utilization of adult dental services," by C. Daniel Mullins, Ph.D., Leonard A. Cohen, D.D.S., M.P.H., M.S., Laurence S. Magder, Ph.D., and Dr. Manski, in the Journal of Health Care for the Poor and Underserved 15, pp. 672-687, 2004. Reprints (AHRQ Publication No. 05-R042) are available from the AHRQ Publication Clearinghouse.

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