The impact of the Affordable Care Act on provision of endodontic services within a dental school setting in Oregon

Objectives: In January 2014 implementation of the Medicaid expansion of the Affordable Care Act (EACA) in Oregon increased the number of children and adults qualifying for the Oregon Health Plan (OHP). Simultaneously, dental care benefits for adult Medicaid members were restored in Oregon after a period of noncoverage. This study evaluated the impact of these changes on the receipt of endodontic services in the Graduate Endodontic Clinic (GEC) at Oregon Health & Science University. Methods: A retrospective electronic health records (EHRs) database review was conducted from July 2010 through June 2017, a seven-year period covering 3.5 years before (pre–EACA) and 3.5 years after (post–EACA) implementation of EACA. The number of completed anterior, premolar and molar non-surgical root canal therapies (NS-RCT) was retrieved from de-identified EHRs by targeting dental codes. Pre– and post–EACA frequencies were compared and analyzed by patient age [<21 years (children) versus adults], payer mix [OHP versus non-Medicaid (self-pay and private insurance)], and tooth type (anterior, premolar and molar) using Chi-square tests (P < 0.05). Results: The number of procedures provided for patients covered by OHP post–EACA compared to pre–EACA was increased by 363 percent. There was an 18 percent decline in NS-RCT provided for non-OHP patients (P < 0.0001). Post–EACA increases in frequency applied to anterior, premolar, and molar NS-RCT (P < 0.0001), with the greatest increase in frequency post–EACA occurring for premolar NS-RCT procedures (666 percent). Conclusions: By eliminating barriers to care greater numbers of vulnerable people in Oregon sought and received endodontic services at the GEC.