A study by the PPC evaluating consumers’ experiences in the first year of the Iowa Dental Wellness Plan (DWP) found that by and large, the people it serves had significant, unmet oral health needs and less access to dental care prior to joining the plan, suggesting greater access to care after enrollment.
The DWP provides dental benefits for members enrolled in the Iowa Health and Wellness Plan (IHAWP), Iowa’s version of the Medicaid expansion and was enacted to provide comprehensive health care coverage to low income adults. It has a unique earned benefits structure designed to encourage preventive health care-seeking behaviors. Enrollees earn additional covered services when they return for regular periodic recall exams every 6-12 months. The study compared experiences of DWP members to those in the Medicaid dental program.
Some key findings of the study include:
Demographic Characteristics and Health Status
- DWP members were significantly more likely to be older, male, and white compared to Medicaid members.
- DWP members reported lower oral health status as compared to Medicaid members, yet both groups reported oral health status was lower than their physical and mental health status.
- Approximately 6 out of 10 members across both groups reported using dental care since joining the plan.
- 4% of both groups reported seeking dental care in an emergency department since joining the plan.
- More than 8 in 10 DWP members did not have dental insurance before enrolling, which was significantly higher than the 6 in 10 new Medicaid members who did not have dental coverage prior to enrolling.
- Almost 7 in 10 DWP and Medicaid members reported a need for dental care in the year before joining their plan, whereas three-quarters of DWP and Medicaid members reported a need for care after joining their plan.
- Significantly more DWP members reported an unmet need for dental care before joining the plan. However, there was no difference between the two groups in unmet need for dental care after joining. In both groups, fewer members had an unmet need for dental care after joining their plan compared to before joining, which suggests both groups experienced improved access to care upon enrolling.
- Significantly fewer DWP members had a regular dentist before joining their plan compared to Medicaid members. The percentage of members with a regular dentist after joining were nearly equal between the two groups, which represents a considerable increase in the proportion of DWP members having a regular source of dental care after joining the plan.
- DWP members rated the dental care they had received since joining the plan significantly better than Medicaid members.
Member Experience with Dental Plan
- 16% of DWP members did not know that they were enrolled in this plan.
- One-third of DWP and 27% of Medicaid members had tried to find a DWP dentist but were not able to. A quarter of DWP and 34% of Medicaid members said it was difficult to find a dentist who accepts DWP.
- Two-thirds of DWP members said that their plan covered their current dental care needs, although almost a quarter did not know if needed services were covered.
- There was not a significant difference between Medicaid and DWP members’ overall ratings of their dental plan.
- DWP members were significantly more likely than Medicaid members to recommend their plan to others.
Overall, DWP members had lower oral health status compared to Medicaid members, and had more unmet needs and less care received prior to joining their program as compared to new Medicaid members. Both groups reported similar access to and utilization of services since joining their plan. Utilization among members of both programs was reported to be relatively high (60%) and unmet need declined following enrollment in both programs. There was limited understanding among DWP members about the earned benefit model used in the DWP, though it is not clear how much this lack of knowledge affected their ability to receive care.
This study is part of a broader evaluation of the DWP that includes provider adequacy, provider surveys, cost, and outcomes. It will be followed by another consumer survey to measure changes in member experiences when they have been in the plan for a greater length of time. To read the complete report, click here.