# Medicaid expansion, dental visits and expenditures in veterans, older adults, and the foreign-born

## TL;DR

Medicaid expansion under the ACA increased dental visits for foreign-born individuals but had no significant effect on veterans or older adults.

## Contribution

This study provides new evidence on the impact of Medicaid expansion on dental care access for vulnerable populations.

## Key findings

- Foreign-born individuals in Medicaid expansion states had higher odds of dental visits (OR = 1.17).
- Dental expenditures for foreign-born individuals increased by $31 but were not statistically significant.
- No significant changes in dental visits or costs were observed for veterans or older adults.

## Abstract

We assessed the relationship between implementation of the Patient Protection and Affordable Care Act (ACA), indicated as a state expanding Medicaid, dental visits, and costs in U.S. military veterans, older adults ≥ 65 years, and foreign-born individuals. Using the 2012–2016 Medical Expenditure Panel Surveys for a secondary data analysis, logistic and two-part regressions were used to model dental visits and costs as a function of key explanatory variables. Differences-in-differences estimates compared changes in dental visits and costs in Medicaid expansion to non- expansion states. Post-Medicaid expansion and ACA implementation, the foreign-born in Medicaid expansion states had higher odds of a dental visit compared to those in non-Medicaid expansion states (OR = 1.17, 95% CI, 1.05–1.32) in adjusted analysis. While they spent $31 more than the predicted per capita expenditure of $395, this increase was not statistically significant. The changes in dental visits and expenditures for veterans and older adults ≥ 65 years were not statistically significant. These findings suggest that the ACA, through expansion of Medicaid programs has improved access for the foreign-born while controlling costs. Health care reform initiatives like Medicaid expansion can enhance access to dental care and help mitigate the economic and access to care barriers vulnerable population groups like the foreign-born face.

The online version contains supplementary material available at 10.1038/s41598-025-03964-y.