Lack of preventive dental coverage can contribute to a range of serious health complications and drives health costs for both emergency and medical services. Federal law requires states to provide dental coverage and benefits for their children who are covered by Medicaid and the Children’s Health Insurance Program (CHIP).
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However, there is no requirement for states to provide adults enrolled in Medicaid with dental coverage. Consequently, states have an unlimited range in determining and administering dental coverage in their states.
Maryland State Senator Malcolm Augustine (D – Prince George’s County) recently spoke to State of Reform about his recently passed bill that mandates Medicaid dental coverage in the state beginning Jan. 1st, 2023. Sen. Augustine got inspired to introduce Senate Bill 150 because he attended a free dental service event at the University of Maryland where he saw many people being served who did not have dental coverage.
“My constituents shared with me how they could not afford the out-of-pocket dental care, [how] they suffered, and [how] they had long waited for this event. In retrospect, I noticed some of these folks had not smiled, and this was just wrong, simply wrong. When I learned that there was a gap of coverage, I felt it was a very important hole that needed to be filled for Marylanders.”
Since 2018, many states have addressed the gap in dental coverage for adults or expanded their dental coverage. Currently, for Medicaid expansion for adults:
- 2 states offer no dental benefits (Alabama and Tennessee);
- 6 states offer emergency-only coverage to relieve pain and infection (Arizona, Georgia, Hawaii, New Hampshire, Utah, and West Virginia); and
- The remaining 42 states and DC offer some form of limited coverage or extensive dental coverage
Sen. Augustine expressed that Maryland was an outlier state in still needing to fill this gap in coverage. There was still opposition to SB 150 based on the financial commitment the state would be needing to provide. At the same time, Sen. Augustine said the financial commitment is a statement of their values and the data shows the benefit will actually lower costs in the long-term.
“When I looked at the data, [it] showed us that this would save us money in the long run,” he said. “For example, with improved dental care you are able to identify other problem areas for folks because you save money by getting care for them earlier … in the long run, [this] would be a net positive for us. Other people may not have seen it that way.”
Sen. Augustine is excited about the passage and implementation of his bill. He said he and his colleagues have already received positive feedback from a variety of different constituents for passing this legislation.
The next dental policy hurdles states need to address are the number of dentist providers who accept Medicaid and how to lower individual barriers or challenges people face. Individual barriers include the lack of awareness of dental benefits, gaps in oral health literacy, and knowledge that oral health equates to general health.
The American Dental Association (ADA) emphasizes the need for increased Medicaid reimbursement for dental care:
“Many dentists are reluctant to treat Medicaid patients, citing . . . low reimbursement rates, administrative burdens, worries about complying with Medicaid regulations, perception that no-show rates will be high, lack of clear information about existing dental benefits, transportation challenges that patients may face, issues of cultural competency, including language barriers, and the need to educate this patient group about the benefits of regular oral care.”
To help address these issues, CMS invites state Medicaid agencies to develop action plans to improve their dental coverage. CMS stands ready to help provide technical assistance to any state that requests help. CMS has already assisted 24 states and DC, and encourages the remaining states to request assistance.
ADA also developed a toolkit to help state dental associations work with the Medicaid program.