January 11, 2022
Medicaid — the health care program jointly funded by states and the federal government to provide comprehensive health care services to 75 million people nationwide — guarantees comprehensive dental benefits for children. The same is not true for adults, though. Adults who rely on the program are often forced to make difficult decisions about seeing a dentist, going to an emergency department (ED), or wondering how much pain they can endure.
Recently, there has been an important national conversation about the need to include dental benefits in Medicare, and rightfully so. Seniors and people with disabilities served by Medicare have gone without necessary oral health care for far too long. But we want to shine a light on the need to advocate for an adult dental benefit in Medicaid too, especially as 2022 state legislative sessions start to ramp up.
The Current Dental Coverage Landscape for Medicaid-Eligible Adults
Today, more than 76 million Americans lack access to dental coverage — three times the number of people without medical insurance. This lack of coverage disproportionately impacts Black and Latino people, tribal communities, people with disabilities, and those in rural America, among others.
The lack of dental benefits available to Medicaid-eligible adults contributes to this gap in coverage. Today, it is optional for state Medicaid programs to provide dental coverage to adult enrollees. Through the incredible work of community advocates and policymakers, some states have acted to strengthen their Medicaid programs by adding adult dental coverage. However, many state Medicaid programs continue to offer only limited benefits or no coverage at all.
As of 2022, 10 states cover dental care only for emergencies and three do not provide any coverage at all (a group at CareQuest Institute has been studying specific procedures and services covered by Medicaid in each state). This leaves millions of people without the accessible, equitable, and integrated health care they need.
The Case for Strengthening Medicaid Dental Coverage
Here are three reasons why the time is now to strengthen Medicaid dental coverage for adults:
1. Healthy mouths are an equity issue.
Historically marginalized communities are hit with a double whammy when it comes to oral health. Not only do adults with low incomes, those living in rural communities, and Black, Indigenous, and other people of color experience higher rates of poor oral health, but they are also disproportionately represented in Medicaid.
Medicaid-eligible adults also experience significantly higher rates of diseases linked to poor oral health, like cardiovascular diseases, oral cancers, and substance use disorders, according to a study in The Journal of The American Dental Association. This only compounds the impact on peoples’ health that can result from a lack of access to necessary preventive oral health care.
To address these overarching challenges experienced by Medicaid-eligible adults, we need to include comprehensive dental benefits as part of their health care. And recent CareQuest Institute research shows that strengthening a Medicaid program by adding adult dental coverage has positive impacts on the oral health outcomes of patients.
2. Dental coverage creates cost savings for all.
Adults with low incomes or otherwise living in poverty spend a significantly higher portion of their annual income on dental care than those with higher incomes — and still face significant unmet needs — according to CareQuest Institute research.
This often leaves Medicaid-eligible adults with a last resort to seek dental care at hospital EDs. Nationally, Medicaid enrollees ages 21–64 make up 39.5% of all ED visits for nontraumatic dental conditions and account for 33.9% of all costs. The average charge per ED visit for patients with Medicaid is $1,400, and research indicates that nearly 79% of these visits could have been addressed in a dental office.
Making dental coverage a required benefit for adult Medicaid enrollees can help divert care from hospital settings to dental offices and community health centers, which could translate into potential savings of nearly $2 billion per year.
3. Our economy depends on it.
With many industries still pinched for workers because of the pandemic, it is high time we give those looking for a job a leg up. Interviewing for a job can be nerve-racking under the best circumstances. Now imagine you have missing teeth, or it hurts to talk during an interview.
CareQuest Institute research conducted prior to the pandemic found ensuring all working adults on Medicaid have access to routine dental care would increase the employability of 9,972 currently unemployed adults — creating $14.2 million in federal tax revenue and saving $7.9 million in unemployment benefits.
What You Can Do Today
Oral health advocates have been working tirelessly to include adult dental benefits in Medicaid — and they’ve made real progress. With state legislatures gearing up for their legislative sessions, health leaders and other advocates from across the health care space can join in and engage with policymakers today. CareQuest Institute, in collaboration with partners, created a Medicaid Adult Dental Benefit Coverage Checker, created a tool kit with information that makes it easy for anyone to advocate for comprehensive dental coverage. To aid advocates and providers pursuing state-based strategies, CareQuest Institute also built a Medicaid adult dental benefit forecasting tool in collaboration with Virginia Health Catalyst.
Simultaneously, it’s up to all of us to push for a federal solution. According to CareQuest Institute research, 65% of American adults strongly agree that comprehensive oral health care for adults should be covered by Medicaid.
In Congress, both the House and the Senate have introduced bills to make this a reality. This summer, Congresswoman Nanette Barragan (D-California) filed the Medicaid Dental Benefit Act (H.R. 4439), and Senator Debbie Stabenow (D-Michigan) and Senator Ben Cardin (D-Maryland) introduced a similar bill. These bills would permanently remove a major barrier to care and ensure that low-income Americans in every corner of our country have stable and consistent access to the health care they need and deserve. (You can see Congresswoman Barragan talk about oral health disparities during CareQuest Institute’s recent event with The Hill.)
Medicare and Medicaid are a lifeline for low-income and elderly communities. While there has been a major push to include dental coverage in Medicare, we must also address the needs of those on Medicaid. That way, we can provide comprehensive dental coverage for all.