Sunday, June 1, 2025
6/1/2025
Medicaid coverage of treatment for periodontal disease and its impact on health outcomes - 7. PROJECT SUMMARY This proposal addresses an unmet need in public health by evaluating the role of Medicaid coverage for treatment of periodontal disease (TPD). Periodontal disease negatively impacts oral health and quality of life. Prevalent among all adults, periodontal disease is even more common in low-income populations served by Medicaid, causing tooth loss and dental pain and representing a significant public health challenge. TPD with scaling and root planing followed by maintenance therapy is the standard of care, but state Medicaid programs are not obligated to offer dental coverage to adults, leading to considerable inter-state variability in coverage for TPD. TPD may improve clinical outcomes and be associated with improving control of chronic diseases like diabetes, but observational data evaluating these effects is considerably confounded. Better evidence is needed on the relationship between providing coverage for TPD with health outcomes, especially for at-risk populations like those covered by Medicaid. State Medicaid programs have initiated coverage for TPD at various times, resulting in a natural experiment that allows us to evaluate the treatment effect of TPD coverage on both oral and comprehensive health. By leveraging a quasi-experimental design using the comprehensive source of all Medicaid claims data from 2016 through 2023, the Transformed Medicaid Statistical Information System (T-MSIS), we will evaluate the effect of implementing Medicaid coverage for TPD across states that implemented this benefit at discrete points in time, allowing us to isolate the treatment effect of TPD specifically while accounting for staggered policy adoption and state and time fixed effects. Our first aim is to evaluate the effect of TPD coverage on tooth loss, emergency department (ED) use for dental problems, and oral healthcare costs. We hypothesize that coverage for TPD will result in a decrease in tooth loss, ED dental use, and dental costs among all Medicaid beneficiaries in affected states. Our second aim will evaluate the impact of TPD coverage on the short-term and long-term complications of diabetes among beneficiaries with diabetes. We hypothesize a reduction in complications such as hyperglycemic crises, diabetic ulcers, retinopathy, and nephropathy. The proposed work builds on prior analyses of Medicaid dental benefits by focusing on a specific procedure with more established implications for comprehensive health, by our use of a novel difference-in- differences estimator that is robust to the realities of Medicaid dental policy adoption and by incorporating both oral health and comprehensive health outcomes. Our proposal is of high relevance to Medicaid policymakers as well as health systems and clinicians by guiding decisions on oral health coverage to improve health in at- risk populations. Our findings will provide important evidence on the contribution of TPD on the health of Medicaid beneficiaries and help develop further oral health coverage and interventions for the Medicaid population.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).