Dental Care for Adults with Intellectual & Developmental Disabilities

Vertical photo of the image reflected on a mirror of a woman with down syndrome cleaning her teeth in the bathroom

Problem

Adults with intellectual and developmental disabilities face many barriers to dental care, and it’s unclear whether expanding Medicaid dental coverage improves access.

Adults with intellectual and developmental disabilities (IDD) are among the most underserved in dental care. This population has more periodontal disease, untreated tooth decay, and poor oral hygiene than U.S. adults without IDD. Because about 60 percent of individuals with IDD are covered by Medicaid, insurance policy plays an important role in access to dental care for this group.

While Medicaid covers all medically necessary dental coverage for children, states have discretion over adult coverage, and only a small number provide extensive dental benefits. Recent legislative efforts in several states have introduced, expanded, or restored adult dental benefits, including targeted enhancements for adults with IDD. However, little research has examined whether these policy changes are associated with better dental-care access and utilization among adults with IDD.

Solution

NORC is examining whether Medicaid dental benefit changes are associated with better care access and utilization among adults with IDD.

NORC, through a CareQuest Institute for Oral Health grant, is examining how changes in state Medicaid dental benefits relate to service access and utilization among adults with IDD. Our mixed-methods approach comprises three main research activities: a policy review, pre- and post-claims analyses, and in-depth interviews.

During the policy review, we will identify states that modified Medicaid adult dental benefits between 2017 and 2021. We will group them into distinct policy scenarios reflecting how the coverage was expanded, restored, or restructured for adults, including those with IDD. Pre- and post-claims analyses will be conducted in four states that represent different policy scenarios to compare dental care utilization before and after benefit changes for adults with and without IDD.

Finally, in-depth interviews with parents and caregivers of adults with IDD in one of the selected states will explore the experiences of adults with IDD in accessing dental care, as well as any challenges related to Medicaid dental coverage.

Result

Findings will aid in weighing whether changes to medicaid dental benefits can shift dental care access for adults with IDD.

The project will produce a white paper bringing together the policy review, claims analysis, and caregiver interviews. It will show what dental service utilization looked like for adults with IDD before and after states changed adult dental benefits, and include qualitative data about the current experiences of families.

State Medicaid agencies, oral health advocates, and disability organizations are actively weighing whether their states should add or restore adult Medicaid dental benefits, and they have had little evidence specific to this population. Pairing claims data with caregiver accounts gives them both the measurable pattern and the reasons behind it, informing decisions about which coverage approaches to pursue and where gaps remain.