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What’s Next for Medicaid? Oral Health for All | Commentary

By Steve Pollock On the 50th anniversary of Medicaid, it’s time to ensure the oral health of all Americans.  

Fifty years ago, the healthcare landscape in America changed forever when President Lyndon B. Johnson signed into law legislation establishing Medicare and Medicaid. Originally developed to cover medical expenses for poor children, their parents, and elderly and disabled Americans receiving public assistance, Medicaid has evolved over time to cover larger segments of the uninsured population, with the most recent expansions resulting from the Patient Protection and Affordable Care Act.  

While Medicaid has undergone many changes throughout its lifetime, its overall objectives have remained the same — to link the uninsured to adequate medical care and reduce the financial burden of medical expenses to those with limited or no resources — and the program has been largely successful.  

But, as we reflect on what Medicaid has accomplished, it’s also important to look ahead to the next 50 years — our work is far from finished.  

Despite the great strides made to provide coverage to those who need it most, 83 million Americans still face obstacles in receiving dental care each year. As more Americans become eligible for Medicaid — average enrollment is projected to increase by 3 percent annually over the next 10 years — the number of those who face barriers in receiving dental care will continue to rise unless state and federal leaders act now.  

Policymakers have long recognized the importance of dental health in children. The Early and Periodic Screening, Diagnosis, and Treatment program, a 1967 amendment to Medicaid legislation, expanded health coverage for eligible children, including ensuring access to dental care. Subsequent legislation, like the Children’s Health Insurance Program, further expanded coverage to low-income children who didn’t qualify for Medicaid but could not afford private health insurance, and has seen incredible success. A recent report issued by the U.S. Department of Health and Human Services found 80 percent of CHIP enrollees saw a dentist in the past year, a significantly higher rate of access and utilization than for children who do not have coverage.  

While states are required to provide comprehensive dental benefits to children covered by Medicaid and CHIP, dental benefits for Medicaid-eligible adults are optional, so the range and scope of adult benefits varies widely by state as a result. Currently, only 15 states provide comprehensive dental care to adults under Medicaid, and four states offer no adult dental coverage at all. Many states have gone back and forth on the extent to which they cover dental benefits for adults due to financial pressures. Without a consistent source of dental coverage, people often do not participate in the routine dental visits. Foregoing preventive oral care can have disastrous results, especially for those suffering from chronic conditions, such as diabetes and heart disease.  

For states concerned with the cost of Medicaid — consider this: A 2012 report found when Medicaid recipients go to the emergency room with a dental problem, even when they do not need emergency treatment, it costs the state nearly 10 times more than if preventive care had been given by a dentist.  

To illustrate this further, let’s look at the state of California, which recently reinstated Medicaid dental benefits for adults. A recent analysis found that when it eliminated dental coverage for adults in 2009, not only did their ER costs rise but the impact was disproportionately felt by young adults, members of racial and ethnic minorities, and those living in urban areas. By providing coverage to those who need it most, Medicaid helps bridge gaps and overcome inequities, having a dramatic impact on health in communities across the country. Good oral health also enhances Medicaid recipients’ ability to gain and keep jobs. Clearly, access to regular preventive dental care is crucial for controlling costs, in addition to improving health, over the long term.  

We have made significant strides in children’s oral health, but they will be lost if adults can’t access preventive care. I urge lawmakers to require comprehensive adult dental coverage for Medicaid recipients to ensure all Americans have equal access to preventive dental care, regardless of their age or income level. Now is the time for us to act, giving adults the basic health care they need to lead happy, healthy and productive lives.  

Steve Pollock is president and CEO of DentaQuest.

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