Medicaid dental coverage and racial/ethnic variation in preventive dental care and unmet needs during pregnancy

Abstract Background Maintaining oral health during pregnancy is important for maternal and child health, yet many low-income individuals face barriers to dental care. Medicaid dental benefits (MDBs) vary by state and may influence access to preventive services and unmet dental need during pregnancy. We examined whether state MDBs for pregnant adults were associated with dental cleaning and unmet dental need, overall and by race and ethnicity. Methods We analyzed 2012–2021 Pregnancy Risk Assessment Monitoring System data from 45 states in a pooled cross-sectional design, restricting to Medicaid-enrolled pregnant adults ( > = 21 years). Outcomes were receipt of dental cleaning and reporting unmet dental need during pregnancy. Primary exposure was state MDB status (limited/extensive vs. emergency/none). Survey-weighted multivariable models with state and year fixed effects estimated adjusted percentage-point (pp) differences; subgroup models were stratified by Hispanic, non-Hispanic White, non-Hispanic Black, and non-Hispanic Other. Results Among Medicaid-enrolled pregnant women, 34.1% reported a dental cleaning and 10.8% reported unmet dental need. Living in a state with MDBs was associated with a 6.7 pp higher likelihood of receiving a dental cleaning (95% CI: 4.0, 9.5) and a 4.0 pp lower likelihood of reporting unmet dental need (95% CI: −6.4, − 1.7). After adjusting for covariates, Hispanic and non-Hispanic Black women were more likely to receive dental cleaning (6.3 and 4.1 pp, respectively) and less likely to report unmet dental need (-3.8 and − 2.2 pp) compared to non-Hispanic White women. In subgroup analysis, MDBs were associated with a higher likelihood of receiving dental cleaning within non-Hispanic Black (9.1 pp; 95% CI: 2.6, 15.6), Hispanic (8.3; 95% CI: 1.6, 15.1) and non-Hispanic White (5.7; 95% CI: 2.0, 9.4) women. For unmet dental need, MDBs were associated with lower likelihood only among non-Hispanic White women (-4.5 pp; 95% CI: -7.8, -1.1); estimates for Hispanic and non-Hispanic Black women were not statistically significant. Conclusions The presence of state MDBs was associated with greater use of preventive dental care and lower unmet dental need during pregnancy. Having MDBs affected all major ethnic and racial groups, with the largest gains in dental cleaning observed among minoritized groups.