Dental Health and Dental Care Utilization Among Able-Bodied Adults on Medicaid in Kentucky After Medicaid Expansion: A Mixed Methods Study

Abstract Background. Dental utilization remains low among adults on Medicaid, despite the ACA expansion increasing access to care in many states. It remains unclear whether low utilization reflects low demand or other barriers. Our objective was to examine factors associated with poor perceived dental health and low dental utilization among adults on Medicaid. Methods. We conducted a large survey of able-bodied adults (N=9,363) on Medicaid in Kentucky from between May and September 2018, which included questions on perceived dental health and utilization of dental care. Semi-structured interviews were also conducted with a subset of participants (N=127) from May to November 2018. Results. 37.8% of respondents reported fair or poor oral health, higher than the 26.2% with fair or poor physical health. 47.6% indicated needing dental care in the last six months, but only half of this group reported receiving all the care they needed. Both low demand and a number of barriers, including lack of coverage for needed services and lack of access to care (low provider availability, transportation difficulties), appeared to explain low rates of utilization. Conclusions. Low dental utilization reflects a combination of low demand and barriers to care. Coverage and access issues could be mitigated by expanding the range of covered services and increasing provider availability.