Emergency Dental Care in the ACA Era: Rural-Urban Disparities and Their Association With State Medicaid Policy

Rural US populations face greater barriers to dental care than urban residents. This study examines emergency department (ED) visits for nontraumatic dental conditions (NTDCs) among adults, comparing rural and urban areas. It also explores how Medicaid expansion and varying state Medicaid dental policies influence the likelihood of NTDC-related ED visits.

We conducted a cross-sectional analysis using 2019 ED data from eight states. Descriptive statistics characterized NTDC-related ED visits by patient, visit, and county-level variables across four Medicaid policy groups. Chi-squared tests and T-tests assessed rural-urban differences in visit characteristics and payer mix. Logistic regression models estimated the likelihood of NTDC ED visits by rurality and payer type, adjusting for sociodemographic factors and stratified by Medicaid expansion and adult dental benefit status.

Rural NTDC ED visits were shorter (2.5 h) and less costly ($1602) than urban visits (over 3 h, $2532). Analysis of rurality and payer mix revealed three key patterns: (i) rural residents consistently had higher visit rates than urban residents in three of the four groups; (ii) uninsured patients-both rural and urban-had the highest probability of NTDC ED visits in three of the four groups; and (iii) among Medicaid-covered visits, rural enrollees in non-expansion states without adult dental benefits had the highest likelihood of NTDC ED visits.

This study highlights continued ED reliance for NTDCs 5 years post-ACA, driven by Medicaid policy and access gaps. Expanding rural oral healthcare remains vital for improving access, especially for the uninsured.