February 26th, 2015
While comprehensive dental coverage is a required benefit for children served by Medicaid, the same is not true for adults. Dental benefits are optional for adults enrolled in Medicaid, and dental coverage is often among the first programs to be trimmed in tight fiscal times—most recently, Illinois Gov. Bruce Rauner (R) made such a proposal. Forty-six states and the District of Columbia currently offer some dental benefit to Medicaid-enrolled adults, but only thirty-two cover services beyond emergency care, and even fewer, fifteen, offer a comprehensive benefit.
As many states expand Medicaid coverage for adults through the Affordable Care Act (ACA), there are new opportunities to increase much‐needed dental coverage in Medicaid and avoid the dangerous and costly consequences of untreated dental disease.
A February 17 webinar hosted by the Center for Health Care Strategies (CHCS), “Dental Coverage and Access for Adults in Medicaid: Opportunities for States,” highlighted the experiences of two Medicaid-expansion states—Colorado and Kentucky—in implementing dental benefits for Medicaid-enrolled adults. The webinar was the first in a series funded by the DentaQuest Foundation and the Robert Wood Johnson Foundation as part of a CHCS initiative to improve oral health care access and quality for low-income adults. The webinar began by outlining the national dental coverage and access landscape for Medicaid-enrolled adults, as well as strategies undertaken to expand dental benefits.
Inadequate dental coverage is a significant barrier to oral health care access for low-income adults, who often cannot afford to pay out-of-pocket and have no other consistently available options for oral health care. Low-income people are 40 percent less likely than those with higher incomes to have visited the dentist in the past twelve months, and that frequent lack of care drives an epidemic of dental disease in this low-income population. Further, 42 percent of people with incomes below 100 percent of the federal poverty level (FPL) have untreated tooth decay, compared with 12 percent of Americans with incomes above 400 percent of the FPL. Oral health care access is even more challenging for vulnerable populations—such as people with chronic illness, racial/ethnic minorities, or people with disabilities—who have more tooth decay, dental infections, and tooth loss than the general adult population.
The nondental consequences of dental disease include elevated risks for diabetes, heart disease, and stroke, as well as potential lost workdays and reduced employability. Oral health care coverage and access challenges have also led to an increase in dental-related hospital visits over the past several years. Because up to 16 million newly eligible adults are expected to gain Medicaid coverage by 2024, many state Medicaid agencies are reconsidering how they can meet the oral health needs of this population. Read the rest of this entry »