Study: Dental care rose among low-income pregnant women after 2015 Medicaid change

More pregnant women enrolled in Medicaid are getting dental care after a 2015 change in state regulations that expanded Virginia Medicaid coverage.

A new study from Virginia Commonwealth University’s School of Dentistry and Business found Medicaid-enrolled pregnant women who self-reported having dental insurance jumped from 44.4% to 71.6% between 2013-14 and 2016-19, the three-year period following the change, while those receiving dental services grew from 30.3% to 44.3%.

Prior to the 2015 change, emergency extractions were the only dental service coverage available for pregnant enrollees.

Medicaid is “definitely a huge sigh of relief for people who need care,” said Shillpa Naavaal, lead author of the VCU study, especially for operations like root canals and crowns that can cost upward of $2,000 out of pocket.

However, researchers say many pregnant people enrolled in Medicaid still don’t know they have dental coverage, and more work needs to be done to increase awareness.

A 2015 regulation issued by former Gov. Terry McAuliffe’s administration expanded Medicaid benefits to include comprehensive dental coverage for pregnant women aged 21 and older through 60 days postpartum as part of the A Healthy Virginia Plan.

Oral health problems during pregnancy are associated with serious health consequences for both mother and baby, the VCU study reports, including high blood pressure, premature birth and low birth weight.

The purpose of the study, Naavaal said, was to understand when or how the change would impact pregnant Medicaid enrollees.

“The policy was put in place, and things kind of moved on,” Naavaal said. “We really didn’t know what happened after.”

According to the Virginia Department of Medical Assistance Services, nearly 35,000 pregnant Virginians are enrolled in Medicaid as of this month.

Researchers analyzed data from the Virginia Pregnancy Risk Assessment Monitoring System, a survey designed to capture women’s experiences during pregnancy in the years before and after Virginia’s policy change.

While the increase in dental care is an encouraging sign, Naavaal said, the data indicate some pregnant women don’t realize they have dental benefits through Medicaid.

There are many ways to increase awareness of the benefit, Naavaal said, such as media coverage and Medicaid directly informing enrollees and medical and dental providers.

Medicaid-enrolled pregnant women may not think about dental care during their pregnancy if they don’t know about the benefits, Naavaal said, but maternal care providers could inform them of the coverage and importance of using it.

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Additional barriers may also prevent low-income women from getting dental services while pregnant. For example, it’s possible that some women in the study couldn’t schedule time for an appointment within their window of eligibility or could not find a provider nearby who accepted Medicaid patients.

Virginia lawmakers voted to expand Medicaid eligibility again in 2019 after years of Republican opposition by increasing the income threshold for eligibility to 138% of the federal poverty level, currently $18,754 for a single individual.

In 2021, the state’s budget included dental care coverage for all new and current Medicaid enrollees ages 19 to 64 and coverage for pregnant women regardless of their immigration status.

“Hopefully, after five years, we do the study again, we see that there are only a few that don’t know or that everybody now knows that they do have coverage,” said Naavaal.

The Smiles for Children program offers dental services for pregnant Medicaid enrollees. Details can be found on the Virginia Department of Medical Assistance Services website.