Adult Medicaid Dental Changes, 2019

For those paying attention to health care legislation, 2019 included continued debate over Affordable Care Act (ACA) Medicaid expansion. Efforts to implement restrictive eligibility policies, such as minimum work requirements, continue. News coverage of these types of debates, however, overshadowed important work across more than half of states to improve access and increase a host of benefits, including dental services for adults. In many ways, 2019 was a banner year for state action on Medicaid adult dental benefits.

Although states are required to provide dental benefits for children covered by Medicaid and the federal Children’s Health Insurance Program (CHIP), adult dental coverage is not similarly mandated. States have the option to limit the type or amount of services and populations they will cover. States can exclude adult dental services overall. As a result, tremendous variation exists across programs. Though nearly all states cover some dental care for adult Medicaid beneficiaries, less than half provide extensive dental benefits.

Public understanding of the connection between oral health and overall health has grown in recent years. Policymakers also recognize the potential cost savings associated with providing dental benefits and regular care to adults. Much of this growing awareness and increase in public and political attention to the enhancement of services is attributed to the tireless work of community- and state-based advocates.

As they are non-mandated, adult dental benefits are often targeted for reduction or total elimination when state budgets are strained. With few exceptions, this was not the case in 2019. Bolstered by strong state economies, advocates led the charge and were able to secure the legislative and administrative victories for their Medicaid adult dental programs in at least 14 states. See below for details on each victory.

Expansion or Enhancement of the Existing Benefit:

Colorado – Effective July 1, 2019, the FY2020 state budget increases the annual dental benefit maximum for adults from $1,000 to $1,500. Additionally, House Bill 19-1038 establishes dental coverage for pregnant adults enrolled in CHIP.

Delaware – Under Senate Bill 92, the state will begin covering preventive and restorative dental services for adult Medicaid recipients in 2020. Until now, Delaware was only one of three states that did not provide any dental coverage for adult Medicaid recipients.

Massachusetts – Effective April 1, 2019 and continuing through June 30, 2020, the FY2019 and FY2020 state budget restored periodontal services to adult Medicaid recipients.

Nevada – Assembly Bill 223 directs the state Department of Health and Human Services to seek a federal waiver to provide diagnostic, preventive, periodontal, and restorative dental care to adult Medicaid recipients with diabetes.

Utah – Senate Bill 11 expands coverage for adult Medicaid recipients age 65 and older, those dual-eligible for Medicare and Medicaid, through the University of Utah School of Dentistry and/or its associates throughout the state.

Vermont – Effective Jan. 1, 2020, the FY2020 state budget increases the dental annual benefit maximum for adults from $510 to $1,000 and allows for up to two preventive visits per year without a copay and without the visits being counted toward the member’s annual maximum.

Washington – Senate Bill 5274 establishes a Compact of Free Association (COFA) Pacific Islander dental care program, making no-cost dental coverage available to adults from COFA nations (the three sovereign states of Micronesia) who are income-eligible for Medicaid.

Charting a Path for Future Enhancements:

New Hampshire – House Bill 692 requires the Medicaid managed care program to provide dental benefits to recipients. The legislation establishes a working group to assist the state Department of Health and Human Services in developing a plan to incorporate an adult dental benefit into a value-based care platform.

Texas – House Bill 4533 directs the state to develop and launch a pilot project for people with intellectual and developmental disabilities, as well as those with other disabilities like vision and hearing, to receive support and services within the Medicaid managed care system, including dental services. The pilot is slated to begin in 2023.

Virginia – The FY2020 state budget includes an amendment that directs the Virginia Department of Medical Assistance Services to study and report on the costs incurred by Medicaid recipients related to emergency department visits for dental issues.

Launching New Services:

Maryland – As of June 1, 2019, the Medicaid Adult Dental waiver program provides dual eligible adult recipients with an $800/year (and $1,600 over the first 18 months through the end of 2020) benefit for diagnostic, preventive, and restorative care.

Washington– Launched in January 2019 in Cowlitz, Thurston, and Spokane Counties, the Oral Health Connections pilot program provides oral health services to pregnant and diabetic adult Medicaid recipients. Enrolled recipients will have access to an integrated dental and medical system in which their medical practitioner will address their oral health and refer them to participating dentists. These dentists will provide care and treatment aimed at enhancing their overall health. Participating providers will receive an enhanced reimbursement rate for providing these services. The program aims to determine if added care can lead to improved health and reduced costs.

Increasing Access to Existing Benefits and Services:

California – The FY2020 budget includes $20M for the CalHealthCares loan repayment program for Medicaid dental providers. Under the program, recently graduated dentists are eligible for up to $300,000 of student loan repayment in exchange for five years treating at least 30% Medi-Cal patients.

Hawaii – Effective Jan. 1, 2019 two of the state’s Medicaid managed care companies, Aloha Care and Ohana Health, began offering a new limited adult preventive dental health service on a trial basis to its Medicaid enrollees. Coverage includes an annual exam, fluoride treatment, bi-annual cleanings, one set of x-rays per year and a non-emergency tooth extraction or filling.

Kansas – The FY2020 state budget includes a $3M increase in adult dental Medicaid reimbursement rates to bring more providers into the program.

Maryland – Senate Bill 158/House Bill 332 establishes a capital grants program to institute or expand dental services in community health centers, thereby strengthening the oral health safety net provider system that serves a growing population of Marylanders needing immediate and ongoing dental care.

2019 Remains Important for Oral Health

Still, this year was not without its challenges.

Despite tremendous efforts by state advocates, and significant public outcry, Alaska saw the near total elimination of the Medicaid adult dental benefit as drastic cuts were implemented across all sectors of the state budget. The total Medicaid Alaska budget was reduced by $77M ($58M in general funds and $19M in federal funding). This included $27M for the Medicaid adult dental benefit. After decades of robust dental coverage, adult Medicaid recipients now only have access to an ‘emergency’ benefit.

In Minnesota, the Medicaid adult dental benefit was also threatened. Although not implemented, the Senate budget included cuts to their Medicaid program to offset the costs associated with the upcoming sunset of the state’s Medical Provider Tax. If enacted, these reductions would have eliminated the adult dental benefit entirely, removing even emergency benefits for adults. Ultimately through a budget compromise, the Medical Provider Tax and the Medicaid adult dental program were preserved.

Yet, the positive gains made across the country are encouraging and should motivate advocates to continue working toward expanded adult Medicaid dental benefits. Advocacy efforts continue to evolve in response to policy changes, budget fluctuations and shifting federal priorities. Stay up to date on this landscape at whatsnew.dentaquest.com to remain prepared for the challenges that lie ahead.