The Impact of Discriminatory Healthcare Experiences on Use of Medicaid-Funded Dental Care Services in California

Background and Purpose. Dental insurance is a critical factor that enables the use of dental services; lack of coverage contributes to disparities in oral health. Despite the urgent need to improve access to dental care for individuals with low income and/or disability, Medicaid coverage of dental care is limited and varies by state. Only a few states, such as California, provide comprehensive dental care coverage to adult enrollees of Medicaid. However, even with the availability of services in California, this Medicaid benefit has been underutilized, and many eligible individuals remain untreated. Stemming from social disadvantages, many Medicaid enrollees encounter service barriers that go beyond insurance coverage, and the present study calls attention to discriminatory experiences in healthcare settings. Type of health insurance has shown to be a source of discrimination, and patients with Medicaid are particularly prone to adverse experiences such as disrespect and/or unfair treatment during patient–medical service provider interactions. The present study aims to explore the extent to which prior experience of healthcare discrimination poses a barrier to seeking dental care among individuals covered by Medicaid in California.

Methods. Using a sample of Medicaid enrollees aged 18 and older drawn from the 2017 California Health Interview Study (CHIS; N = 4779), the present study examined the rates of discriminatory healthcare experiences and use of dental services, as well as the effect of discriminatory experiences on dental service use. A logistic regression model of dental service use was tested to estimate the odds associated with discriminatory experiences after adjusting for covariates (age, gender, marital status, race/ethnicity, education, English proficiency, and self-rated teeth condition).

Results. More than 60% of Medicaid enrollees were female, about 75% were unmarried, and more than half (51.1%) reported an education of high school graduation or less. Nearly 64% of the sample reported having been treated unfairly when getting medical care over their entire life, and about 60% used dental service in the past year. Prior experience of discrimination reduced the odds of using dental service by 18% (Odds Ratio = 0.82, 95% Confidence Interval = 0.72−0.93, p < .01). Being female, Hispanic or African American (vs. White), married, and more educated increased the odds of using dental service, whereas limited English proficiency and fair/poor ratings of teeth condition reduced the odds.

Conclusions and Implications. The study identified prior experiences of healthcare discrimination as a service barrier that decreases the odds of Medicaid enrollees using their entitled dental benefits. Findings provide implications for promoting the use of dental care services among adults who are often socially disadvantaged and determining more efficient management of public healthcare expenditures.