{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T02:33:56Z","timestamp":1778121236100,"version":"3.51.4"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,4,28]],"date-time":"2024-04-28T00:00:00Z","timestamp":1714262400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000072","name":"National Institute of Dental and Craniofacial Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000072","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Comm Dent Oral Epid"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>In the United States, adult dental benefits are optional in the state\u2010managed, public insurance program, Medicaid. States also have the option to adapt their Medicaid program via waivers which pair healthy behaviour incentives (HBI) with cost\u2010sharing. These waivers have proven ineffective, but the empirical evidence has ignored differences between states. This study aims to evaluate the impact of four state's HBI Medicaid waiver on dental visits among low\u2010income adult population subject to incentives and cost\u2010sharing requirements by the HBI waiver.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Analysing biannual data from the Behavioural Risk Factor Surveillance System's Oral Health module (2008\u20132018) with a Difference\u2010in\u2010Differences design, this study estimated the effect of a Healthy Behaviour Incentive waiver on the probability of visiting the dentist in the past year. The three states that implemented an HBI Waiver (Indiana, Michigan and Wisconsin) were analysed separately. Secondary outcomes included being uninsured and having all teeth extracted. Matrix Completion methods accounted for dynamic treatment and tested for non\u2010common trends. Inference was based on randomization inference tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Only in Michigan was an HBI waiver consistently associated with a significant increase in the probability of a dental visit (Est. =\u20095.6%\u2010points, <jats:italic>p<\/jats:italic>\u2009=\u2009.01). There was little convincing evidence that HBI waivers were associated with being uninsured or having all teeth extracted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Between 2010 and 2019, many states have implemented an HBI waiver, each with a different approach to incentivizing dental visits. These implementation differences may explain the heterogeneous effects by state. More work is needed to evaluate how Medicaid waivers impact health outcomes in low\u2010income populations.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cdoe.12965","type":"journal-article","created":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T03:18:41Z","timestamp":1714360721000},"page":"708-715","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Incentivizing dental services in healthy behaviour Medicaid waivers"],"prefix":"10.1111","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0375-8090","authenticated-orcid":false,"given":"Jason","family":"Semprini","sequence":"first","affiliation":[{"name":"Department of Epidemiology University of Iowa College of Public Health  Iowa Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,4,28]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e13703"},{"key":"e_1_2_11_3_1","unstructured":"MACPAC.Compendium: State Medicaid Fee\u2010for\u2010Service Adult Dental Services Coverage Policies.2021Accessed January 26 2023.https:\/\/www.macpac.gov\/publication\/compendium\u2010states\u2010medicaid\u2010fee\u2010for\u2010service\u2010adult\u2010dental\u2010services\u2010coverage\u2010policies\/"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001181"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001344"},{"key":"e_1_2_11_6_1","first-page":"1","article-title":"Dental care utilization among adults aged 18\u201064: United States, 2019 and 2020","volume":"435","author":"Cha AE","year":"2022","journal-title":"NCHS Data Brief"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1215\/03616878-4193618"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1215\/03616878-2007-039"},{"key":"e_1_2_11_9_1","unstructured":"KFF.Medicaid Waiver Tracker: Approved and Pending Section\u00a01115 Waivers by State.2023Accessed May 5 2023.https:\/\/www.kff.org\/medicaid\/issue\u2010brief\/medicaid\u2010waiver\u2010tracker\u2010approved\u2010and\u2010pending\u2010section\u20101115\u2010waivers\u2010by\u2010state\/"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1017\/jme.2021.59"},{"key":"e_1_2_11_11_1","unstructured":"MACPAC.The Use of Healthy Behavior Incentives in Medicaid.2016Accessed November 16 2022.https:\/\/www.macpac.gov\/publication\/the\u2010use\u2010of\u2010healthy\u2010behavior\u2010incentives\u2010in\u2010medicaid\/"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.0431"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2016.303192"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13672"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.01145"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.6185"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2017.0048"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/JAC.0000000000000359"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2018.05427"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2018.0331"},{"key":"e_1_2_11_21_1","volume-title":"Innovation diffusion: an event history analysis of states adoption of the 1915(c) waiver for people living with HIV\/AIDS","author":"Nelson BS","year":"2007"},{"key":"e_1_2_11_22_1","unstructured":"CMS.Healthy Michigan|Medicaid.2009Accessed May 24 2023.https:\/\/www.medicaid.gov\/medicaid\/section\u20101115\u2010demo\/demonstration\u2010and\u2010waiver\u2010list\/82066"},{"key":"e_1_2_11_23_1","unstructured":"CMS.Healthy Indiana Plan|Medicaid.2015Accessed May 24 2023.https:\/\/www.medicaid.gov\/medicaid\/section\u20101115\u2010demo\/demonstration\u2010and\u2010waiver\u2010list\/81641"},{"key":"e_1_2_11_24_1","unstructured":"CMS.Iowa Wellness Plan|Medicaid.2017Accessed May 24 2023.https:\/\/www.medicaid.gov\/medicaid\/section\u20101115\u2010demo\/demonstration\u2010and\u2010waiver\u2010list\/81706"},{"key":"e_1_2_11_25_1","unstructured":"CMS.Wisconsin BadgerCare Reform|Medicaid.2013Accessed May 24 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