08:41 AM

Protecting the Progress Made Expanding Medicaid Adult Dental Benefits

Protecting the Progress Made Expanding Medicaid Adult Dental Benefits

A key area of focus for the DentaQuest Partnership for Oral Health Advancement is the expansion of Medicaid and Medicare adult dental benefits.

To that end, we join the Oral Health Progress and Equity Network (OPEN) in calling on Congress to advance policies that address the important role of oral health in keeping people healthy, in particular for pandemic response. The DentaQuest Partnership with OPEN ask Congress to include policies in the next COVID-19 relief package that:

  1. Stabilize state budgets to protect access to essential oral health care by increasing the Federal Medical Assistance Percentage (FMAP) by 12% and further increasing the FMAP for Medicaid dental services by 5%.

  2. Provide an immediate infusion to state health departments and oral health programs by establishing an oral health infrastructure fund to respond to crisis-related oral health needs.

Advocates are critical to maintaining momentum and influencing Congressional action.

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 preventive care to adults.

More than half of states last year improved access and increased a host of public benefits, including dental services for adults, in large part due to community- and state-based advocacy. In fact, 2019 was an important year for state action on Medicaid adult dental benefits. At least 14 states implemented legislative or administrative changes to enhance their state’s program, and momentum continued into early 2020. Working closely with policymaker champions in their state legislatures, advocates in Arizona, Hawaii, Kansas, Maine, New Hampshire, Virginia and West Virginia led the charge to expand and enhance the public adult dental benefit. Advocates in Delaware, New Hampshire and Vermont also worked to advance or put in place newly enacted enhancements.

But the COVID-19 crisis changed advocates’ focus almost overnight. Oral health advocates, in particular, stepped up to ensure the physical, emotional and financial health of their communities. Some activities include

  • serving as navigators for individuals in need of insurance and other assistance;
  • advocating for the expansion of telehealth to ensure patients can access the care they need;
  • supporting safety net providers and private practice providers alike in communicating changes in service delivery models to the public and securing financial support to maintain operations;
  • identifying alternative ways for patients in need to get care; and
  • serving as information hubs for consumers, providers and the community overall.

These are critical tasks at a time when we need to protect existing benefits.

COVID-19 is rapidly decimating state budgets with no tax gains while businesses remain closed or limited and unemployment grows. Tax revenues support state health care, education, public safety, transportation and other vital programs, and Medicaid is a frequent target for budget cuts, even in less tumultuous times.

While states must 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 or exclude adult dental services overall — making adult dental one of the easier programs to cut.

Some states are already faced with budget deficits for the remainder of fiscal year 2020 and many, if not all, will face deficits for fiscal year 2021 and beyond. In fact, the National Association of State Budget Officers says states are currently forecasting steep revenue declines of up to 20%.

Medicaid dental benefit cuts would be shortsighted and devastating for many adults.

Regular dental care is necessary to prevent or slow the progression of oral disease, yet one in five working-age adults does not get needed dental careExpensive out-of-pocket costs can be prohibitive — low-income families spend 10 times more on their dental care than wealthier families. Without dental coverage or the ability to afford care, many adults postpone treatment until their condition becomes too painful to endure. This means they need more expensive and extensive oral care than they would if they had seen a dentist earlier in the disease process. Some adults could even avoid the pain and urgency altogether because their oral health issue could have been entirely prevented with regular dental care.

What’s more, poor oral health contributes to higher risk for the development of diabetes, cardiovascular disease, stroke, adverse mental health outcomes ­­­­and other conditions. Without access to appropriate dental care, many people living with these chronic illnesses could see their conditions worsen and require additional care — often in emergency departments (EDs) — that increases costs ultimately borne by state Medicaid budgets.

Without access or referral to definitive follow up care, many patients will also have to return to the ED. Not only is this cycle untenable for hospitals, health care costs and patients, but untreated chronic dental conditions can become life-threatening and even lead to inpatient admission. We should never accept these outcomes, and right now, we cannot afford additional strain on our hospitals.

Medicaid adult dental benefits were reduced during previous recessions and, in some cases, eliminated entirely. Nationally, studies show that reducing or eliminating these benefits leads to significant increases in dental-related ED visits — an increasingly more expensive dental care setting. Conversely, when dental benefits are implemented or reinstated, the use of preventive services increases and ED visits for non-traumatic dental conditions decreases.

In the coming weeks and months, oral health advocates will remain focused on meeting the immediate needs of their communities while keeping pressure on policymakers to protect vital public programs, services and benefits. We join these seasoned advocates in leveraging the collective, long-built political will to expand and enhance benefits and access and protect gains that have been made. Will you?