A Growing Number of States Are Expanding Their Medicaid Dental Coverage and Increasing Reimbursements

By Emma Yasinski

 

The United States is in the midst of the largest Medicaid expansion ever, and almost every state now includes some dental coverage.

“It’s really a positive story,” Evelyn Ireland, executive director of the National Association of Dental Plans, told Incisor. “We seem to be marching toward getting almost all the states with some level of adult dental coverage in the Medicaid program.”

But challenges remain.

In the early 2000s, many states cut dental coverage to save money, but since the passage of the Affordable Care Act, Medicaid has been expanding its dental coverage. The program is required to cover dental care for children, but there is wide variability in how much coverage it must provide adults.

 

Quality dental care is crucial not only to maintaining and improving patient health, but also to reduce overall spending on medical care.

 

Only two states, Alabama and Tennessee, provide no dental benefits to adults on Medicaid. Eleven states provide emergency-only care, and 37 states plus Washington, DC provide benefits beyond emergency dental care. The number of patients enrolled in Medicare more than doubled to 74 million from 32 million between 2014 and 2017.

According to the National Association of Dental Plans, 5.2 million people in California still lack dental benefits; of those who do have coverage, many still don’t receive dental care.

 

For many dentists, reimbursement, administrative requirements, and missed appointments make accepting the insurance unappealing.

 

Quality dental care is crucial not only to maintaining and improving patient health, but also to reduce overall spending on medical care. A 2014 study showed that healthcare costs for patients with coronary heart disease were 67 percent lower if they received preventive dental care than if they didn’t. The savings ranged from 31 percent to 67 percent for several other illnesses such as stroke and diabetes.

There are two main problems: the first is that many patients who receive dental coverage as part of Medicaid expansion aren’t aware that they do. California had cut dental benefits in 2009, restored limited benefits in 2014, and just last year gave full dental benefits to Medicaid participants. Juan Sevilla, who has Medicaid in California, told The Orange County Register that he had no idea his benefits also included dental care.

The second problem is that only 39 percent of dentists accept patients on Medicaid. For many dentists, reimbursement, administrative requirements, and missed appointments make accepting the insurance unappealing.

Dr. Darryl Ruby, who previously had a private dental practice and now volunteers care at a free clinic, told The Orange County Register that in order to avoid fighting the organization for payment, he’d rather provide volunteer dental care at a free clinic than accept Medicaid.

Medicaid reimbursement has been low, but Ireland says it’s increasing.

California used $500 million to help increase reimbursement in October 2018. Other states, including Colorado and Kansas, are increasing their reimbursement outlays as well. Ireland recommended that dentists regularly check their region’s reimbursement rates and Medicaid requirements. “Local and state advocates are aware of those challenges and are doing what they can to increase funding and reimbursement under those programs,” she said. “If you’re looking for more patients, that’s where they are: in the [Medicaid] program.”

 

Author: Contributing writer Emma Yasinski received her Master’s of Science (MS) in science and medical journalism from Boston University. Her articles have also appeared at TheAtlantic.com, Kaiser Health News, NPR Shots, and Genetic Engineering and Biotechnology News.

Other Recent Incisor Articles by Emma Yasinski include:

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