# Role of State Medicaid Policies in Improving Access to Dental Care among Low-Income Adults

> **NIH NIH K08** · BOSTON UNIVERSITY MEDICAL CAMPUS · 2020 · $131,517

## Abstract

PROJECT SUMMARY
The purpose of this study is to examine how access to dental care among low-income adults is impacted by
state Medicaid policies regarding eligibility, dental coverage, cost-sharing and dentist reimbursement. Oral
health is integral to overall health, economic productivity and well-being. Yet access to dental care continues to
be a major public health problem for low-income adults, leading to untreated disease, pain, poor systemic
health and substantial economic burden. In recent years, several policy changes under the Affordable Care Act
(ACA) such as Medicaid expansion and dependent care coverage could significantly impact access to dental
care among the poor non-elderly adults. In addition, there is extensive cross-state variation in terms of dental
benefits covered for Medicaid adults. These variations provide natural experiments to examine the effect of
Medicaid policies on access to dental care. Moreover, under the current health reform discussions, state
Medicaid programs are anticipated to gain autonomy in resource allocation, yet may receive significantly less
federal funding, making the need for robust evidence on relative effectiveness of Medicaid policy alternatives
available to the states paramount. The overarching goal of this application is to advance the research career of
the candidate (Dr. Singhal) by protecting her time for training and research on these critical issues in oral
health policy. This goal will be accomplished through additional training in complementary disciplines of
econometrics and machine learning, and their application to estimate the impacts of Medicaid coverage and
payment generosities on access to dental care. The project brings together complementary secondary data
from multiple sources including: large national survey data (National Health Interview Survey), administrative
enrollment and claims data (Medicaid Analytic eXtract) and linked survey and claims data. Leveraging these
data and training resources, this project will: 1) develop synthetic indices of Medicaid dental coverage and
payment generosities; 2) estimate the effect of each policy alternative and combined generosity indices on
various measures of access to dental care; and 3) predict the relative effectiveness of policy alternatives and
their combinations on access to dental care. We will use econometric methods including instrumental
variables, difference-in-difference and regression discontinuity models to develop the generosity indices and to
estimate the impact of Medicaid generosity. To develop and validate the predictive model, we will use
supervised machine learning approaches (e.g. decision tree learning) using linked survey and claims data. The
results will provide evidence needed to inform future strategies to ensure efficient use of health care resources
to reduce oral health disparities. The completion of this project will also enable Dr. Singhal to establish a
research program as an independent research investiga...

## Key facts

- **NIH application ID:** 9949693
- **Project number:** 5K08DE027720-03
- **Recipient organization:** BOSTON UNIVERSITY MEDICAL CAMPUS
- **Principal Investigator:** Astha Singhal
- **Activity code:** K08 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $131,517
- **Award type:** 5
- **Project period:** 2018-07-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9949693

## Citation

> US National Institutes of Health, RePORTER application 9949693, Role of State Medicaid Policies in Improving Access to Dental Care among Low-Income Adults (5K08DE027720-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9949693. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*