Access to public adult dental benefits across the country was growing. In 2019, at least 14 states implemented legislative or administrative changes to enhance their state’s programs, with positive momentum going into 2020.

Now, with echoes of the 2008 recession and states facing significant budget shortfalls due to COVID-19, many advocates are concerned that the Medicaid adult dental benefit could be at risk.

“Dental benefits for adults are often the first to get cut among state health programs,” said Trenae Simpson, grants and programs manager at the DentaQuest Partnership for Oral Health Advancement, during a recent webinar on the topic of state advocacy and Medicaid adult dental benefits. “So as potential budget cuts loom, we’re working hard to make sure that doesn’t happen.”

Advocates in several states, including three who served as expert speakers on the webinar, are working to create a more robust adult dental benefit and reminding decision makers that cuts to these benefits would be shortsighted.

Increased Access Means Lower Costs

The speakers underscored the reality that lack of access to oral health care disproportionately impacts those who are most vulnerable. And that the prevalence of health care inequities among communities of color, in addition to lower-income and rural populations, has become especially apparent during the pandemic.

“Those in poverty spend 10 times more as a proportion of their family income on dental services compared to high-income families,” said Julie Frantsve-Hawley, PhD, CAE, director of analytics and evaluation at the DentaQuest Partnership for Oral Health Advancement. “They spend significantly more money on emergency treatments, instead of receiving regular preventive care.”

Reducing preventable dental-related emergency room (ER) visits is especially important, Hawley said, because adults without dental coverage or the ability to afford care often delay treatment until issues become severe or painful. These ER visits are significantly more expensive, costing an estimated $2.1 billion per year. And research indicates that nearly 79% of these visits could have been addressed in a dental office, a savings of up to $1.7 billion per year.

The lack of preventive care also puts people at higher risk of other chronic health issues, as growing research shows that oral health impacts the whole body. Treating chronic conditions like asthma, heart disease and diabetes, which can all be exacerbated by poor oral health, adds millions more in preventable health care costs to the system.

Advocacy and Awareness Is Critical

Greater awareness of these issues has allowed advocates to push back when government leaders decide to cut funding to adult dental benefits, which is a reality in many states. Advocates spoke on the webinar about their experiences tackling the issue in their own states.

Jessie Menkens of the Alaska Primary Care Association fought back last year, when the state was confronted with a massive cut to the adult dental benefit. “We knew that funding prevention for oral health would eliminate so many more serious issues down the line, so we fought hard to keep the policies,” Menkens said. She added transparency and a focus on data were key to changing people’s minds. More specifically, they recorded and documented every call or meeting with legislators and every interview with reporters, allowing them to ensure that their messaging was clear and consistent. The Alaska legislature ultimately voted to fund the benefit.

Gail Brown, director of the New Hampshire Oral Health Coalition, shared that her group focused their messaging on the need for “responsible management of scarce resources,” emphasizing the high cost of delayed and deferred dental care — something she says people across the political spectrum can agree on. Despite the New Hampshire government having a 60% turnover rate, meaning that advocates have to meet with new legislators every two years, Brown and her team were still able to rally long-term support for dental benefits. She said communication was key to getting this work done — and will be key to preserving it.

“Good communication is so much more important now given the pandemic,” Brown said. “Government officials are more accessible virtually — which is something we can use to our advantage when advocating for these benefits.”

Mahak Kalra, senior policy and advocacy director, Kentucky Youth Advocates, has focused on external communication and engagement strategies, too.

"For example, we host weekly virtual forums for advocates to share challenges they are facing and to hear directly from decision makers,” Kalra said. “Our partners in advocacy are then equipped with the tools and knowledge needed to advocate for themselves and those they serve as they navigate the ongoing impacts of the pandemic."

As the webinar closed, Stacey Auger, strategic advisor at the DentaQuest Partnership, emphasized the need for advocates to continue to work together to make progress on these issues. She encouraged participants to join OPEN: Oral Health Progress and Equity Network, a national network of advocates that shares resources, tools and best practices for success.

“Working together,” Auger said, “is how we can create changes that last.”