Millions of Americans are losing their dental coverage as the pandemic-era rule that prevented them from losing Medicaid expired on March 31st.
By Genni Burkhart
State Medicaid officials began reviewing all Medicaid enrollees' eligibility on April 1st, a process called "unwinding," and have started terminating coverage for those who are not eligible. As the unwinding process continues, "eligible" individuals and families, particularly people of color and children, are more likely to be impacted and may lose their medical and dental coverage.
KFF, a nonprofit research organization formerly known as the Kaiser Family Foundation, estimates that up to 15 million people face losing their health insurance. In addition, KFF estimates that 95 million Americans receive Medicaid and CHIP coverage, which provides low-cost coverage for children.
Children at Risk
The loss of medical and dental insurance is a concern for children in all states. Yet, according to Georgetown University Health Policy Institute Center for Children and Families, those living in Delaware, Florida, Georgia, Missouri, Nevada, and Texas are in the greatest danger of losing their coverage. It's important to note that Alabama, Delaware, Maine, Maryland, Tennessee, and Texas don't offer dental coverage as part of their Medicaid plans.
Children can lose Medicaid coverage in one of two ways: they may become eligible for another public coverage program (such as CHIP) and lose their coverage, or they may still qualify for Medicaid but lose coverage for procedural reasons, such as not responding to a state request for address verification.
According to the Center for Children and Families report, states and federal policymakers can prevent putting millions of children at risk of coverage loss by bringing this data to the public's attention and intervening quickly when coverage losses occur.
Millions Could Lack Dental Coverage
With the end of the COVID-19 public health emergency, more than 14 million adults - 28% of Medicaid enrollees - will be unable to access oral health care if their state rules them ineligible. In addition, it's estimated by Carequest, the Institute for Oral Health, that Hawaii, Indiana, Wyoming, Florida, Illinois, Colorado, and North Carolina will all lose coverage by 40% or more, the highest risk level in the nation.
In an April 14th news report by Phil McCausland at NBCNews.com, CareQuest Institute for Oral Health's CEO, Myechia Minter-Jordan, stated the institute felt compelled to publish the data to encourage states and public health agencies to continue helping people maintain access to oral health care.
Raising the Alarm
Forty-seven states provide dental coverage for Medicaid recipients, whether emergency care, limited range, or extensive dental services. However, it's noted that coverage loss will disproportionately affect communities of color.
According to the Centers for Medicare and Medicaid Services, about 25% of Medicaid adults see a dentist annually. Still, Medicaid-accepting dentists can be hard to find, especially in rural areas and for those with limited access to transportation. Those who need dental care most may not be able to get it, leading to further health disparities in the already vulnerable communities of color.
Numerous studies have linked poor dental hygiene to poor overall health, a fact pointed out by those raising this alarm. Even more concerning is that the implications of ignoring this warning can be severe and far-reaching. According to a landmark U.S. surgeon general study published in 2000, poor oral health may increase a person's risk of health problems - a common concern (and knowledge) for many in the dental world.
Growing Demand
The demand for coverage has proliferated since the onset of the COVID-19 pandemic.
According to the same NBCNews.com report, the Centers for Medicare and Medicaid Services, dental services expenditures in Medicaid and CHIP increased from $14.9 billion in 2020 to $17.8 billion in 2021. However, dental services spending remained roughly the same — only increasing from 2.2% to 2.4%.
This data suggests that despite a slight increase in dental service spending, it was outpaced by the overall growth in Medicaid dental service expenditures. As such, the percentage of the spending on dental services stayed roughly the same, further highlighting that dental issues also cost people more than ever before.
The American Dental Association (ADA) reports that dental expenditures hit $162 billion in 2021, up from $95 billion in 2000. The average out-of-pocket cost for dental services has also risen significantly, from $209 in 2000 to $326 in 2018. Additionally, the number of people without dental insurance has increased from 39% to 46% over the same period.
Sixty-three billion was spent out of pocket in 2021, while $25 billion was covered by government programs - meaning individuals shouldering a more significant financial burden for dental care. It also underscores the need for more affordable and accessible dental care, especially for those without dental insurance. Despite that, a 2014 study by the National Institutes of Health found that cuts to dental benefits during the 2008 recession led to higher emergency room visits. Nevertheless, states often cut it as the first item on their budgets.
These cuts have a significant impact on both health outcomes and healthcare costs. Studies have also found that proper access to dental care is essential for systemic health. However, low-income and the most vulnerable populations are often the first to lack or lose coverage. As a result, it is vital to protect dental benefits to ensure the health of all individuals, families, and communities.
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Author: With over 13 years as a published journalist, editor, and writer Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides on the western shores of the idyllic Puget Sound, where she works as the Editor in Chief for the Incisor at DOCS Education out of Seattle, WA.
