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Medicaid managed care organizations (MCOs) expanded adult dental benefits, but coverage generosity and delivery models remain inconsistent with fee-for-service (FFS) plans. Understanding these trends is crucial for equitable dental access.

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Area of Science:

  • Health Services Research
  • Public Health Policy
  • Dental Benefits Administration

Background:

  • Adult dental coverage within Medicaid programs exhibits significant state-level variation.
  • The majority of adult Medicaid beneficiaries are now enrolled in managed care plans, yet details on benefit structures within these organizations are limited.

Purpose of the Study:

  • To analyze trends in the scope, delivery, and enrollment patterns of adult dental benefits offered by Medicaid managed care organizations (MCOs).
  • To evaluate the alignment of dental benefit generosity between MCOs and Medicaid fee-for-service (FFS) programs.

Main Methods:

  • A cross-sectional analysis of adult Medicaid beneficiaries (19+ years) with MCO or FFS coverage across all 50 states and Washington, DC.
  • Utilized a linked national dataset from Centers for Medicare & Medicaid Services administrative sources (2016-2022).

Main Results:

  • States offering comprehensive adult dental benefits via MCOs increased from 64.7% in 2016 to 70.6% in 2022.
  • Mismatched benefit levels between MCO and FFS programs decreased from 51.0% in 2016 to 35.3% in 2022.
  • Comprehensive dental coverage enrollment among MCO beneficiaries rose from 14.2 million (58.7%) in 2016 to 25.3 million (59.8%) in 2022.

Conclusions:

  • While MCO adult dental benefits have grown, their alignment with FFS programs remains inconsistent.
  • The evolving landscape of Medicaid dental benefits necessitates careful consideration for future policy decisions to ensure equitable access.