Medicaid programs are well-positioned to prioritize optimal oral health in their states through adult dental benefits, but systematic changes are necessary to fully address barriers to dental care.
Although Medicaid programs are required to provide pediatric dental coverage for low-income children, extending those benefits to the adult population is optional. Currently 15 states offer extensive dental coverage for low-income adults on Medicaid, while 17 states only provide coverage for dental emergencies or provide no coverage at all.
Robust adult dental benefits can have tremendous impacts on state Medicaid populations:
· Individuals with dental benefits are 42 percent more likely to have a dental checkup within the year than individuals who don’t have coverage. Additionally, when parents receive care, their children are more likely to go to the dentist as well.
· Reducing or eliminating Medicaid adult dental benefits has led to significant increases in dental-related emergency department visit and associated costs in states like California.
· Ensuring low-income adults have access to comprehensive dental coverage can improve employability, as adults lose millions of work hours each year due to dental disease.
· Increasing access to dental coverage can help to reduce disparities as well because untreated dental disease disproportionately afflicts racial and ethnic minorities.
· Treatment of gum disease can lead to better health management — as evidenced by lower health care costs and fewer hospitalizations — among people with common health conditions, such as type 2 diabetes, heart disease, and pregnancy. These links to improved overall health management are particularly critical for Medicaid beneficiaries.
The economic, oral health, and overall health outcomes above are tremendous arguments for states to invest in a Medicaid adult dental benefit, but access challenges will persist without systematic approaches to oral health.
In this month’s publication of Health Affairs, research conducted by the DentaQuest Institute and the American Dental Association shows that emergency department utilization for oral health conditions rose in Kentucky after Medicaid expansion, which included a dental benefit for adults.
In the emergency department, patients generally receive palliative and costly care. A combination of pain-management (usually opioids) and infection management for preventable conditions costs the U.S. health care system an estimated $1.6 billion annually.
Presumably, increasing coverage under Medicaid would have reduced emergency department utilization and associated costs. Why didn’t this happen for Kentucky?
Although Kentucky expanded dental coverage to adults in Medicaid, the state still faced many challenges:
- 23 percent of low-income individuals cited inconvenient locations or time as a reason to avoid going to a dentist.
- Kentucky’s reimbursement for dental services was 44 percent of commercial rates.
- Due to few dental providers in the state, Kentucky had 99 dental health provider shortage areas, and only 39 percent of Kentucky dentists participated in the Medicaid program.
Coverage is a critical first step to ensuring access to dental services for adults served by Medicaid, but it cannot be the only step.
While information in Kentucky suggests that an increase in emergency department use following the addition of an adult Medicaid dental benefit is likely temporary, strategies to improve oral health in a state must go beyond coverage alone.
Key strategies that states must consider include:
- provider capacity and support,
- reimbursement rates,
- dynamic oral health education, and
- the integration of oral health screenings and/or referrals into primary care are.
These factors are critical to ensure that patients receive the most appropriate care in a timely manner and in the most appropriate setting.
Fortunately, organizations like DentaQuest are creating multi-pronged approaches to these systemic oral health challenges.
At DentaQuest, we align philanthropy, science, coverage and care to improve the oral health of all. DentaQuest Foundation delivers millions of dollars in grant funding to hundreds of initiatives across the nation, fostering oral health innovation at the grassroots level. Ideas that prove most promising are leveraged by the DentaQuest Institute, which develops innovative clinical care and practice management solutions to help providers deliver optimal care.
Programs and initiatives that prove to be both effective and scalable by the DentaQuest Institute are then integrated in a broader fashion by DentaQuest Benefits Administration and the DentaQuest Care Group, fueling a comprehensive disease management approach toward health that is prevention-focused and outcome-driven.
We are more than just a dental administrator. We are an incubator of innovation and a proving ground for pioneering initiatives in the oral health space that improve health.
These types of collaborative solutions that incorporate a wide array of stakeholders are imperative to successfully improve oral health in a state and to achieve the Triple Aim – reduce healthcare costs, improve the patient experience, and achieve better health outcomes.