Author ORCID Identifier
0000-0001-5586-5843
Defense Date
2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Healthcare Policy & Research
First Advisor
Peter Cunningham
Second Advisor
Bassam Dahman
Third Advisor
Tegwyn Brickhouse
Fourth Advisor
David Harless
Fifth Advisor
Paula Song
Abstract
This dissertation evaluates the impact of Medicaid dental policy changes in Virginia on adult dental access, utilization, provider participation, and emergency department (ED) reliance, using a combination of policy‑opportunity and econometric estimation approaches. Across three empirical studies, the work examines how expansions of adult dental benefits and reimbursement reforms shape dental service use, provider behavior, and emergency department reliance among Medicaid-enrolled adults.
Paper 1 analyzes statewide administrative claims from the Virginia Department of Medical Assistance Services (DMAS) to assess changes in dental utilization during the first two years of comprehensive adult dental benefits (July 2021- June 2023). Using a two‑part logistic regression model with bootstrapping and predicted marginals, the study estimates a 17.8% probability of any dental use and a 10.6% probability of preventive dental care. The probability of both outcomes was higher in year 2 than in year 1 and varied by race/ethnicity during the study period. The effect of race/ethnicity did not differ by time for any dental visit outcome, but the interaction was significant for the preventive dental visit outcome at p< 0.05.
Paper 2 evaluates the effect of Virginia’s Medicaid dental reimbursement increase on provider participation, employing an econometric interrupted time-series model to measure changes in dentist participation overall and in service volume and intensity 12 months before (July 2021 – June 2022) and after (July 2022 to June 2023) the reimbursement policy implementation and by rurality. Using negative binomial regression within an interrupted time-series framework, adjusted for county population, we found that participation increased across providers, patients, and visits following the reimbursement policy. There was a gradual post‑policy rise in participating dentists (post‑policy slope RR = 1.01, p = 0.032) and large immediate increases in both patients (RR = 2.61, p < 0.001) and visits (RR = 3.04, p = 0.001), indicating strengthened engagement with Medicaid dental services. The interaction between rurality and the post-policy period was not significant, suggesting that rurality did not modify post‑policy trends in any outcomes.
Paper 3 uses Virginia’s All‑Payer Claims Database (APCD) and a difference‑in‑differences design to estimate the impact of adult dental benefit implementation on ED use for dental conditions among Medicaid adults compared with privately insured adults from January 2019 to December 2022. The prevalence of ED dental visits was 3.7% overall, 1.5% among privately insured adults, and 4.9% among Medicaid adults. The adjusted model indicates a relative decline of 39 ED dental visits per 10,000 Medicaid members by the sixth post‑policy quarter (p = < 0.0001). The average reimbursement per ED dental visit was $376 for Medicaid and $1,082 for private insurance.
Providing Medicaid dental benefits improved oral health access and utilization, increased provider engagement, and reduced dental care use in the ED in Virginia. Together, these studies provide a comprehensive assessment of how Medicaid dental policies can improve oral health and offer clear evidence to guide future policy decisions that advance oral health equity for Medicaid adults.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
5-6-2026