In this analysis, we provide new evidence on Medicaid-covered dental office visits and dental-related emergency department (ED) visits during pregnancy and the year following childbirth. We document considerable variation in dental care receipt across states and according to Medicaid coverage of dental benefits, state Medicaid expansion status, and enrollee age.

Why This Matters

Oral health is a vital component of overall health, including during and after pregnancy, when hormonal and behavioral changes increase the risk of dental problems such as periodontal disease and cavities. Over 40 percent of all childbirths in the United States are covered by Medicaid or the Children’s Health Insurance Program (CHIP), and nearly all states have recently extended pregnancy-related Medicaid/CHIP coverage to last through one year after childbirth. However, evidence is limited on how often Medicaid/CHIP enrollees receive dental services during and after pregnancy, as well as how dental service use during this time varies by age and state. Understanding patterns of dental care use can inform policies aimed at improving access to dental care and oral health among Medicaid/CHIP enrollees during and after pregnancy.

What We Found

We found that among enrollees with continuous Medicaid/CHIP coverage who gave birth in the last quarter of 2018:

• Approximately 38.5 percent had at least one Medicaid-covered dental office visit during the perinatal period (pregnancy through one year postpartum), including 20.7 percent of enrollees during pregnancy, 8.4 percent during the first 60 days postpartum, and 25.2 percent between 61 and 365 days postpartum.
• Approximately 3.5 percent had at least one Medicaid-covered dental ED visit during the perinatal period.
• Enrollees younger than 21, for whom dental coverage is mandatory in all states, were significantly more likely to have a dental office visit during the perinatal period compared with enrollees 21 or older. For example, 45.7 percent of enrollees younger than 21 had a dental visit during the perinatal period compared with 37.2 percent of enrollees age 21 or older.
• The share of enrollees with a dental office visit during the perinatal period varied significantly across states.
• Enrollees living in expansion states had significantly higher rates of dental office visits compared with enrollees living in nonexpansion states. For example, 39.4 percent of enrollees ages 21 or older in expansion states had at least one dental visit during the perinatal period compared with 28.7 percent in nonexpansion states.
• Rates of dental office visits during the perinatal period among enrollees age 21 or older were strongly associated with the extent of Medicaid adult dental coverage. For example, between 61 and 365 days postpartum, 27.5 percent of enrollees with full dental coverage had a dental visit compared with 12.5 percent of enrollees with emergency-only coverage and less than 0.4 percent of enrollees with no dental coverage. This pattern held when stratifying by expansion status and adjusting for state of residence, age, eligibility pathway, and rurality.

How We Did It

We identify dental office visits and dental-related ED visits during pregnancy and the year following childbirth using 2018–19 Medicaid/CHIP claims and encounter data from the Transformed Medicaid Statistical Information System representing over 200,000 Medicaid/CHIP enrollees from 45 states and the District of Columbia who had a live-birth delivery in the last quarter of 2018.