The Effects of Medicaid Policy Changes on Adults’ Receipt of Medical and Dental Care and Service Use Patterns in Kentucky and Idaho

This study examines receipt of medical and dental care among non-elderly adults in Medicaid in two states, Kentucky and Idaho, that adopted policy changes aimed at increasing receipt of primary and preventive care. It also examines the impact of cost containment measures adopted by the Kentucky Medicaid program, including new cost-sharing and prior authorization requirements for services and prescriptions. Our primary sample consists of adult Medicaid enrollees ages 19 to 64 in Idaho and Kentucky eligible under TANF or SSI and enrolled during the study period (2004-2008). Descriptive and impact analyses, including linear probability and hazard models, are used to examine the effect of policy changes with administrative enrollment and claims data spanning the period the policy changes were made. Models control for age, gender, race/ethnicity, and eligibility category (TANF or SSI).In Kentucky, preliminary descriptive statistics indicate that following the increase in reimbursement rates for office visits, the shares of adults in Medicaid who had any physician’s visit and any dental visit in the prior year increased by less than 1 percentage point (to 87% and 31%, respectively, in the post period), while the shares who had any preventive physician’s visit and any preventive dental visit decreased by less than 1 percentage point (to 12% and 11%, respectively, in the post period). Additional analyses will examine effects of new cost sharing arrangements, prior authorization requirements, and service limits, which are hypothesized to reduce service use.Preliminary descriptive analysis in Idaho indicates that an estimated 10% of adults in Medicaid had received a preventive physician’s visit following its addition to the adult benefit package, while the share of adults who received any physician’s visit remained constant at 78%. After outsourcing dental care for TANF enrollees to a managed care organization, which increased reimbursement rates to dental providers, the share of adults enrolled in the TANF eligibility category who had any dental visit in the past year increased from 46% to 51%. In contrast, for SSI adults who remained in fee-for-service dental care, there was no change in the share having any dental visits. Similarly, the share of TANF adults who received a preventivedental visit increased from 24% to 29%, while the share of SSI adults who had a preventive dental visit remained constant.While the majority of adults in Medicaid in both states received primary medical care in the past year, rates of preventive care and of dental care use are very low. Preliminary analysis from Idaho suggests that the addition of an adult wellness exam to the benefit package had modest effects on service use and that the adoption of managed care for dental provision for adults in TANF appears to have increased use of preventive dental care and dental care overall among that population. Policy changes such as fee increases, benefit package changes, and delivery system changes can lead to increases in primary care use among adults. However, additional policy changes would be required to address the persistent shortfalls in preventive and dental care receipt.