Adult Medicaid Benefit Generosity and Receipt of Recommended Health Services among Low-Income Children: The Spillover Effects of Medicaid Adult Dental Coverage Expansions

Lipton, Brandy (2019): Adult Medicaid Benefit Generosity and Receipt of Recommended Health Services among Low-Income Children: The Spillover Effects of Medicaid Adult Dental Coverage Expansions.

Abstract

Low-income children are less likely to receive recommended health services than their high-income counterparts. This paper examines whether the design of parental Medicaid benefit packages could serve as a mechanism for reducing income-based disparities in unmet health care needs, considering dental benefits as a case study. Leveraging state-level changes to adult dental benefits over time, I find that coverage is associated with increases of 14 and 5 percentage points, respectively, in the likelihood of a recent dental visit among parents and children directly exposed to the policy. Child effects appear to be concentrated among younger children under age 12.

• Item Type: MPRA Paper
• Language: English
• Keywords: Medicaid, health behavior, disparities, oral health
• Subjects: D - Microeconomics > D1 - Household Behavior and Family Economics; I - Health, Education, and Welfare > I1 - Health > I12 - Health Behavior; I - Health, Education, and Welfare > I1 - Health > I13 - Health Insurance, Public and Private; I - Health, Education, and Welfare > I1 - Health > I14 - Health and Inequality

References

Abdus, S., & Decker, S. L. (2019) Association between Medicaid adult dental nonemergency dental benefits and dental services use and expenditures. Journal of the American Dental Association, 150(1), 24-33.

Agaku, I. T., Olutola, B. G., Adisa, A. O., Obadan, E. M., & Vardavas, C. I. (2015). Association between unmet dental needs and school absenteeism because of illness or injury among US school children and adolescents aged 6-17 years, 2011-2012. Preventive Medicine, 72, 83-88.

Aizer, A., & Grogger, J. (2003). Parental Medicaid expansions and health insurance coverage. NBER Working Paper No. 9907.

American Academy of Pediatric Dentistry. Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents. Chicago, IL: AAPD, 2013. Available at: http://www.aapd.org/media/policies_guidelines/g_periodicity.pdf. Accessed April 9, 2019.

American Dental Association. American Dental Association Statement on Regular Dental Visits. Chicago, IL: ADA, June 2013. American Dental Association. Mouth Healthy: Baby Teeth. Chicago, IL: ADA, 2019. Available at: https://www.mouthhealthy.org/en/az-topics/b/baby-teeth. Accessed April 9, 2019.

Baicker, K., Allen, H. L., Wright, B. J., Taubman, S. L., & Finkelstein, A. N. (2018). The effect of Medicaid on dental care of poor adults: evidence from the Oregon Health Insurance Experiment. Health Services Research, 53(4), 2147-2164.

Baicker, K., Congdon, W. J., & Mullainathan, S. (2012). Health insurance coverage and take-up: Lessons from behavioral economics. The Millbank Quarterly, 90(1): 107-134.

Berdahl, T. A., Friedman, B. S., McCormick, M. C., & Simpson, L. (2013). Annual report on health care for children and youth in the United States: Trends in racial/ethnic, income, and insurance disparities over time, 2002-2009. Academic Pediatrics, 13(3), 191-203.

Berdahl, T. A., Hudson, J., Simpson, L., & McCormick, M. C. (2016). Annual report on children’s health care: Dental and orthodontic utilization and expenditures for children, 2010-2012. Academic Pediatrics, 16(4), 314-326.

Case, A., & Paxson, C. (2002). Parental behavior and child health. Health Affairs, 21(2), 164-178. Centers for Medicare and Medicaid Services. Medicaid Benefits, Dental Care. Baltimore, MD: CMS (n.d.). Available at: https://www.medicaid.gov/medicaid/benefits/dental/index.html. Accessed April 9, 2019.

Chalmers, N., Grover, J., & Compton, R. (2016). After Medicaid expansion in Kentucky, use of hospital emergency departments for dental conditions increased. Health Affairs, 35(12), 2268-2276.

Choi, M. K. (2011). The impact of Medicaid insurance coverage on dental service use. Journal of Health Economics, 30(5), 1020-1031.

Currie J. (2000). Do children of immigrants make differential use of public health insurance? In: Borjas G., editor. Issues in the economics of immigration. Chicago: University of Chicago Press, 271-308.

Cutler, D. M., & Gruber, J. (1996). Does public insurance crowd out private insurance? Quarterly Journal of Economics, 111(2), 391-430.

Davidoff, A., Dubay, L., Kenney, G., & Yemane, A. (2003). The effect of parents’ insurance coverage on access to care for low-income children. Inquiry, 40(3), 254-268.

de Oliveira, C., Watt, R., & Hamer, B. (2010). Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey. BMJ: British Medical Journal, 340, c2451.

Decker, S. L., & Lipton, B. J. (2015). Do Medicaid benefit expansions have teeth? The effect of Medicaid adult dental coverage on the use of dental services and oral health. Journal of Health Economics, 44, 212-225.

DeVoe, J. E., Krois, L., Edlund, T., Smith, J., & Carlson, N. E. (2008). Uninsurance among children whose parents are losing Medicaid coverage: results from a statewide survey of Oregon families. Health Services Research, 43(1), 401-418.

DeVoe, J. E., Marino, M., Angier, H., O’Malley, J. P., Crawford, C., Nelson, C.,…& Gold, R. (2015). Effect of expanding Medicaid for parents on children’s health insurance coverage: lessons from the Oregon experiment. JAMA Pediatrics, 169(1), e143-e145.

DeVoe, J. E., Tillotson, C. J., & Wallace, L. S. (2009). Children’s receipt of health care services and family health insurance patterns. The Annals of Family Medicine, 7(5), 406-413.

Dillender, M. (2017). Medicaid, family spending, and the financial implications of crowd-out. Journal of Health Economics, 53, 1-16.

Dubay, L., & Kenney, G. (2003). Expanding public health insurance to parents: effects on children’s coverage under Medicaid. Health Services Research, 38(5), 1283-1302.

Dye, B. A., Thornton-Evans, G., Li, X., & Iafolloa, T. J. (2015). Dental caries and sealant prevalence in children and adolescents in the United States, 2011-2012. NCHS data brief 191, 1-8.

Edelstein, B. L., & Chinn, C. H. (2009). Update on disparities in oral health and access to dental care for America’s children. Academic Pediatrics, 9(6), 415-419.

Finlayson, T. L., Gansky, S. A., Shain, S. G., & Weintraub, J. A. (2014). Dental utilization by children in Hispanic agricultural worker families in California. Journal of Dental, Oral and Cranofacial Epidemiology, 2(1-2), 15.

Glied, S., & Neidell, M. (2010). The economic value of teeth. Journal of Human Resources, 45(2), 468-496.

Giannobile, W. V., Braun, T. M., Caplis, A. K., Doucette-Stamm, L., Duff, G. W., & Kornman, K. S. (2013). Patient stratification for preventive care in dentistry. Journal of Public Health Dentistry, 92(8), 694-701.

Gomes-Filho, I. S., Passos, J. S., & Seixas da Cruz, Simone. (2010). Respiratory disease and the role of oral bacteria. Journal of Oral Microbiology, doi:10.3402/jom.v2i0.5811.

Hamersma, S., Kim, M., & Timpe, B. (2018). The effect of parental Medicaid expansions on children’s health insurance coverage. Contemporary Economic Policy, Advance online publication. doi: 10.1111/coep.12392.

Howell, E. M., & Kenney, G. M. (2012). The impact of the Medicaid/CHIP expansions on children: a synthesis of the evidence. Medical Care Research and Review, 69(4), 372-396.

Hu, L., Kaestner, R., Mazumder, B., Miller, S., & Wong, A. (2018). The effect of the Affordable Care Act Medicaid expansions on financial wellbeing. Journal of Public Economics, 163, 99-112.

Hudson, J. L., & Moriya, A. S. (2017). Medicaid expansion for adults had measurable ‘Welcome Mat’ effects on their children. Health Affairs, 36(9), 1643-1651.

Isong, I. A., Zuckerman, K. E., Rao, S. R., Kuhlthau, K. A., Winickoff, J. P, & Perrin, J. M. (2010). Association between parents’ and children’s use of oral health services. Pediatrics, 125(3), 502-508.

Jackson, S. L., Vann Jr, W. F., Kotch, J. B., Pahel, B. T., & Lee, J. Y. (2011). Impact of poor oral health on children’s school attendance and performance. American Journal of Public Health, 101(10), 1900-1906.

Kahneman, D., & Tversky, A. (1979). Prospect theory: An analysis of decision under risk. Econometrica, 47(2), 263-291.

Koch, T. G. (2015). All internal in the family? Measuring spillovers from public health insurance? Journal of Human Resources, 50(4), 959-979.

Kranz, A.M., & Dick, A.W. (2018). Changes in pediatric dental coverage and visits following the implementation of the Affordable Care Act. Health Services Research, Advance online publication, doi: 10.1111/1475-6773.13093.

Leininger, L., Levy, H., & Schanzenbach, D. (2010). Consequences of SCHIP expansions for household well-being. In: Forum for Health Economics & Policy, 13(1), 1-32.

Levy, H., Buchmueller, T., & Nikpay, S. (2019). The impact of Medicaid expansion on household consumption. Eastern Economic Journal, 45(1), 34-57.

Lipton, B. J., Wherry, L. R., Miller, S., Kenney, G. M., & Decker, S. (2016) Previous Medicaid expansion may have had lasting positive effects on oral health among non-Hispanic black children. Health Affairs, 35(12), 2249-2258.

Mazumder, B., & Miller, S. (2016). The effect of the Massachusetts health reform on household financial distress. American Economic Journal: Economic Policy, 8(3), 284-313.

Miller, S., Hu, L., Kaestner, R., Mazumder, B., & Wong, A. (2018). The ACA Medicaid expansion in Michigan and financial health. NBER Working Paper No. 25053.

Monheit, A. C., & Vistnes, J. (2015). Does public health insurance for children improve single mothers’ health care use? Journal of Family and Economic Issues, 36(4), 581-592.

Naito, M., Yuasa, H., Nomura, Y., Nakayama, T., Hamajima, N., & Hanada, N. (2006). Oral health status and health-related quality of life: a systematic review. Journal of Oral Science, 48(1), 1-7.

Nasseh, K., & Vujicic, M. (2013). Health reform in Massachusetts increased adult dental care use, particularly among the poor. Health Affairs, 32(9), 1639-1645.

Nasseh, K., & Vujicic, M. (2017a). Early impact of the Affordable Care Act’s Medicaid expansion on dental care use. Health Services Research, 52(6), 2256-2268.

Nasseh, K., & Vujicic, M. (2017b). The impact of the Affordable Care Act’s Medicaid expansion on dental care use through 2016. Journal of Public Health Dentistry, 77(4), 290-294.

Neidell, M., Herzog, K., & Glied, S. (2010). The association between community water fluoridation and adult tooth loss. American Journal of Public Health, 100(10), 1980-1985.

Saloner, B. (2013). Does expanding public insurance prevent material hardship for families with children? Medical Care Research and Review, 70(3), 267-286.

Savage, M. F., Lee, J. Y., Kotch, J. B., & Vann, W. F., (2004). Early preventive dental visits: effects on subsequent utilization and costs. Pediatrics, 114(4), e418-423.

Seale, N. S., & Casamassimo, P. S. (2003). Access to dental care for children in the United States: a survey of general practitioners. Journal of the American Dental Association, 134(12), 1630-1640.

Shane, D. M, & Ayyagari, P. (2015). Spillover effects of the Affordable Care Act? Exploring the impact on young adult dental insurance coverage. Health Services Research, 50(4), 1109-1124.

Shane, D. M., & Wehby, G. L. (2017). The impact of the Affordable Care Act’s dependent coverage mandate on use of dental treatments and preventive services. Medical Care, 55(9), 841-847.

Singhal, A., Caplan, D. J., Jones, M. P., Momany, E. T., Kuthy, R. A., Buresh, C. T., …& Daminano, P. C. (2015). Eliminating Medicaid adult dental coverage in California led to increased dental emergency visits and associated costs. Health Affairs, 34(5), 749-756.

Singhal, A., Damiano, P., & Sabik, L. (2017). Medicaid adult dental benefits increase use of dental care, but impact of expansion on dental services use was mixed. Health Affairs, 36(4), 723-732.

Singhal, S., Correa, R., & Quinonez, C. (2013). The impact of dental treatment on employment outcomes: a systematic review. Health Policy, 109(1), 88-96.

Slade, G. D., & Sander, A. E. (2018). Two decades of persisting income-disparities in dental caries among US children and adolescents. Journal of public health dentistry, 78(3), 187-191.

Sommers, B. D. (2006). Insuring children or insuring families: Do parental and sibling coverage lead to improved retention of children in Medicaid and CHIP? Journal of Health Economics, 25(6), 1154-1169.

Sommers, B. D., Tomasi, M. R., Swartz, K., & Epstein, A. M. (2012). Reasons for the wide variation in Medicaid participation rates among states hold lessons for coverage expansion in 2014. Health Affairs, 31(5), 909-919.

Sommers, B. D., Chua, K. P., Kenney, G. M., Long, S. K., & McMorrow, S. (2016). California’s early coverage expansion under the Affordable Care Act: a county-level analysis. Health Services Research, 51(3), 825-845.

Venkataramani, M., Pollack, C. E., & Roberts, E. T. (2017). Spillover effects of adult Medicaid expansions on children’s use of preventive services. Pediatrics, 140(6), e20170953.

Vujicic, M., Yarbrough, C., & Nasseh, K. (2014). The effect of the Affordable Care Act’s expanded coverage policy on access to dental care. Medical Care, 52(8), 715-719.

Wan, A. K. Seow, W. K., Purdie, D. M., Bird, P. S., Walsh, L. J., & Tudehope, D. I. (2003). A longitudinal study of Streptococcus mutans colonization in infants after tooth eruption. Journal of Dental Research, 82(7): 504-508.

Willis, M. S., Esqueda, C. W., & Schacht, R. N., 2008. Social perceptions of individuals missing upper front teeth. Perceptual and Motor Skills, 106(2), 423-435.