Minnesota medicaid budget cutbacks 2010 and impact on dental service utilization in nursing home residents

Abstract

ABSTRACT Background and Objectives. Oral health is an integral part of maintaining the overall health of every individual and therefore an essential component of primary health care for older adults. Oral health service utilization is multifactorial and financial support plays an important part in determining the degree of oral care received. Past studies report a strong association between dental insurance coverage and dental service utilization by the elderly population. The purpose of this study was to examine the effects of a reduction in dental insurance for enrolled nursing home residents under Minnesota's Medicaid plan in 2010. As part of research hypothesis, it was theorized that Minnesota's Medicaid budget cuts, which took effect in January 2010, resulted in a reduced utilization of basic dental services among nursing home residents. Material and Methods.For this study, a retrospective cross sectional survey method was employed and data were collected from the dental practice software systems used in University of Minnesota's two community-based dental clinics for older adults. The Experimental Group included subjects above 55 years, who were nursing home residents and had dental visits between January 2009 and December 2010 and had any type of Medicaid dental coverage. The Comparison Group included subjects above 55 years of age who were nursing home residents and had dental visits and did not have any Medicaid dental insurance for the same time period. Outcome variables analyzed were dental services provided for MA and non-MA groups in three categories depending upon the changes that occurred after the 2010 Minnesota Medicaid cutbacks. These were: 1) non-impacted, services; 2) reduced services; or 3) eliminated services. Summary dental utilization measures such as overall visits, overall services, as well as visits per patient per year and services per patient per year were also analyzed. Results: For the Experimental (MA) group, no or marginally statistically significant differences were found from 2009 to 2010 in overall dental visits and overall services, although large and statistically significant increases were found in overall visits and services provided for the Comparison (non-MA) group in 2010 versus 2009. No statistically significant differences were found in both MA and non-MA groups for total visits per patient and total services per patient from 2009 to 2010. For those dental services unaffected by the 2010 Minnesota MA benefit changes, no statistically significant changes occurred from 2009 to 2010 for either the MA or non-MA groups. However, large and statistically significant reductions were found from 2009 to 2010 for dental services that were reduced in coverage in the 2010 Minnesota MA dental benefit cutbacks, and extremely large reductions were found for eliminated services in 2010. These reductions in reduced or eliminated dental services during 2010 occurred in both the Experimental (MA) and Comparison (non-MA) Groups. Conclusion. While the overall process of care in these two practices seemed unchanged based on overall visits and services per patient provided in 2009 and 2010, an expected increase in overall dental services and visits occurred among the non-MA patient group in 2010 perhaps to compensate for fewer covered MA services. While no statistically significant differences were found from 2009 to 2010 in utilization of services that were unaffected by the 2010 Minnesota MA service cutbacks as might have been expected, large and significantly different reductions in utilization were found in both the MA and non-MA groups for services that were either reduced or eliminated in 2010. While these results might be a reflection of the US economic downturn during the same time period, they also could suggest that the MA service cutbacks might have led to changes in dental providers' perceptions of all NH patients' ability to pay for these services in 2010. Future larger sample studies with a broader time frame are required to further investigate the effects of 2010 Medicaid benefit cutbacks on dental care utilization, as well as further analyses of changes in specific dental services provided.