Volume 56 | Number 4 | August 2021

Abstract List

Hawazin W. Elani BDS, PhD, Ichiro Kawachi M.D., Ph.D., Benjamin D. Sommers M.D., Ph.D.


To examine changes in access to dental care in states using Section 1115 waivers to implement healthy behavior incentive (HBI) programs in their Medicaid expansion under the ACA, compared to traditional expansion states and nonexpansion states.

Data sources

Behavioral Risk Factor Surveillance System from 2008 to 2018.

Study design

We used difference‐in‐differences analysis to compare changes in three Medicaid expansion states with HBI (Iowa, Indiana, Michigan) to traditional expansion (Minnesota, North Dakota, Ohio) and nonexpansion states (Nebraska, South Dakota, Wyoming) in the same mid‐Western region of the country. The sample included 32 556 low‐income adults.

Data collection/extraction methods


Principal findings

We found no significant changes in dental visits associated with HBI or traditional expansion relative to nonexpansion states. HBI expansion was associated with an increase of 2.2 percentage points in reporting a dental visit in the past year for adults in urban areas ( < 0.05) while the traditional expansion was associated with a reduction of 8.5 percentage points ( < 0.01) in utilization in rural areas relative to nonexpansion states. However, after adjustment for preexisting trends, the coefficients were no longer significant, suggesting that these differences are likely due to preexisting trends.


We did not find evidence of increased utilization of routine dental care associated with HBI programs.