Rafia: Significant expansion of Medicaid dental benefits is win for all


Dr. Kaz Rafia is the chief health equity officer and executive vice president of CareQuest Institute for Oral Health in Boston.

Whether you consider it part of your regular health maintenance or a bit of a chore, going to the dentist — and even having access to oral health care — is a crucial indicator of a person’s health. Yet oral health care has consistently been treated by our health system as nonessential and separate from overall health. Because of this, individuals in communities across the U.S. struggle to access basic oral health care, including nearly 70 million adults who lack dental insurance.

A state’s priorities are reflected in its policies, and for years, dental coverage was not a priority across the U.S. Finally, that notion seems to be changing — so much so that we are experiencing the most significant growth in the number of state Medicaid programs offering adult dental benefits in recent decades. In fact, between 2020-22, nearly half of all states expanded their Medicaid adult dental benefit offerings.

As is often the case when sweeping policy change is necessary, this was long overdue. While states are required to provide comprehensive dental benefits for children covered by Medicaid and the Children’s Health Insurance Program, dental coverage for adult Medicaid beneficiaries is optional. Without additional support from the federal government, states are often faced with difficult budgeting decisions that limit Medicaid adult dental benefits, forgo offering the coverage altogether or prioritize other health care spending.

Count Delaware among the states overdue for a change. Prior to 2020, adult Medicaid beneficiaries had no dental coverage in the state. The good news is Delaware has made significant strides, implementing Medicaid dental benefits for all adult beneficiaries in October 2020 for the first time.

Delaware joins several states across the country in taking crucial steps toward increasing access to oral health care. According to CareQuest Institute for Oral Health’s recently updated Medicaid Adult Dental Coverage Checker, which highlights the progress advocates and policymakers have made to expand adult dental benefits in the past few years, eight states now offer an extensive Medicaid adult dental benefit. That’s double the four states that boasted this in 2020.

It’s not a coincidence that this marked shift in progress coincided with the COVID-19 pandemic, which exposed the deep systemic inequities in our health system. Inequities within oral health, like inequities in other areas of society, are correlated with income and have a racial dimension.

For example, one CareQuest Institute study showed that 65% of respondents who lost their health insurance due to job loss or change in benefits caused by the COVID-19 pandemic had one or more oral health symptoms and did not get any treatment. And the lower a person’s income, the higher the likelihood of having an oral health symptom in the last 12 months. We also know that Black adults are 68% more likely to have an unmet dental need than White adults. These factors, combined with broad public support for providing extensive dental benefits within Medicaid, helped improve access to care for thousands of individuals in Delaware and across the country.

What makes this policy change particularly impactful? In short, it benefits everyone.

Numerous studies show that Medicaid adult dental coverage lowers overall health care spending on chronic disease management and emergency department usage. Dental emergency department visits alone cost an estimated $2.1 billion per year, and research indicates that nearly 79% of these visits could be addressed in a dental office — a potential savings of up to $1.7 billion per year. It also boosts oral health outcomes for patients and increases employment opportunities.

The momentum has continued into 2023, as several states continue to move toward expanding their adult dental benefits. As some states head into the new legislative session this fall, we have an opportunity and an obligation to do more. In Delaware, policymakers should heed the recommendations of the Dental Care Access Task Force, which has called for the further expansion of the Medicaid adult dental benefit. To do so, the task force has recommended that Delaware remove the maximum benefit caps, increase the flexibility of the preauthorization of the emergency benefit and enhance the benefit to cover services such as crowns, root canals and dentures.

We encourage Delaware to take this next step toward offering an extensive Medicaid adult dental benefit and continue the important work of expanding coverage and access.

There also needs to be dual action between the federal and state levels. Congress must pass broad legislation encouraging federal action to include oral health care in all state Medicaid programs. It is time to prioritize oral health and provide whole-person health care for every American.

Health benefits aren’t a yes/no proposition but a continuum. There is a big difference between dental coverage for emergencies only and a benefits package that includes a full spectrum of preventive and restorative dental care with no annual maximum. And those differences can be felt in ways that last a lifetime.

Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.

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