By Mary Otto
Authors of the recent Families USA brief “Treating Pain is Not Enough: Why States’ Emergency-Only Dental Benefits Fall Short,” observe that in emergency-only care states, adult Medicaid dental benefits are typically limited to “extracting an infected tooth but not filling or restoring a tooth.”
“Some states face challenges making even this minimal care accessible,” the authors note.
In spite of efforts by dental directors and oral health coalitions to preserve dental services in their states, history has offered many examples of adult dental benefits disappearing from Medicaid programs.
Because adult Medicaid dental benefits are not federally mandated, they often end up on state budget chopping blocks in times of fiscal austerity. Ironically, the care dwindles or disappears when beneficiaries may need them the most.
The lack of coverage and money to pay for care takes a toll on the oral health of low-income adults, with an estimated 42 percent of poor American working-aged adults suffering from untreated tooth decay, according to federal data.
Without access to timely care, decay progresses and increases the risk for such complications as tooth loss and pain. Since toothache sufferers often seek relief in emergency rooms, that further drives up overall health care costs without addressing underlying dental issues.
States sometimes do re-think and reverse dental care cuts because of this realization. For example, after making deep cuts in adult dental benefits under Medicaid nearly a decade ago, the state of California at the beginning of this year restored many covered services. In “Giving Medicaid Enrollees Something to Smile About,” Emily Bazar of Kaiser Health News looks at the ups and downs of adult Medicaid dental programs in California and elsewhere.
Since the passage of the Affordable Care Act, Medicaid expansion in some states has improved adult dental coverage, and in some cases, access to dental services.
Findings in a study published by Health Affairs suggest that childless adults were significantly more likely to have gone for a dental visit in states that had expanded their Medicaid programs and offer adult dental benefits. But ironically, poor parents were less likely to have gotten care.
“One possible explanation for the disparity is that after expansion, newly enrolled childless adults might have exhausted the limited dental provider capacity that was available to parents before expansion,” the study’s authors concluded.
The shortage of dentists willing to treat Medicaid enrollees has complicated the search for care in many communities. In part, that’s because dentists are less likely to work in low-income urban and rural places with high Medicaid populations. In addition, dentists who are available in those communities often cite low reimbursement rates and red tape as disincentives for becoming a Medicaid provider.
Adult Medicaid dental benefits change, so be sure to check with your state health department or dental director to verify the current status of coverage. Here are some resources to help:
- In 2015, approximately 38 percent of dentists participated in Medicaid and CHIP, according to the American Dental Association’s (ADA) Health Policy Institute (HPI). This chart, developed by HPI and based upon ADA and federal data, offers a state-by-state look at dental provider participation in Medicaid and CHIP.
- This fact sheet, also from HPI, offers additional background and analysis of Medicaid dental coverage and utilization.
- For a useful look at the big picture, see this January 2018 fact sheet from the nonprofit Center for Health Care Strategies. It offers fairly up-to-date state-by-state information about adult dental benefits under Medicaid.
