Expanding Medicaid Dental Coverage: A Path to Relief for Many
For those like Carlton Clemons in Nashville, Tennessee, the absence of dental coverage under Medicaid meant enduring agonizing pain from a rotting wisdom tooth. But change is in the air. This year, six states began or expanded their Medicaid programs to offer dental coverage for adults.
A Lifeline for Those in Pain
Medicaid, the federal and state health insurance program for the poor, mandates dental coverage for children but not adults. However, this oversight is now being addressed in several states.
Carlton Clemons, aged 67 and living on $1,300 a month from Social Security and disability payments, couldn’t afford dental care. For months, he suffered through excruciating pain. When Tennessee introduced a program this year to provide dental care to adult Medicaid recipients, it was a lifeline. Tennessee is investing approximately $75 million annually in this initiative. After his tooth was finally pulled at the Meharry Medical College School of Dentistry in July, Clemons exclaimed, “Man, I thought I had made it to heaven because the pain was over.”
Economic and Health Costs of Neglected Dental Health
Delaying dental care can have serious economic and health consequences, both for individuals and society at large. Preventable dental conditions lead to up to 2.5% of emergency room visits, costing about $2 billion annually, according to a Texas A&M University study. The annual loss of productivity due to untreated oral diseases amounts to an additional $45 billion, as reported by the federal Centers for Disease Control and Prevention.
A National Effort to Improve Access
While all states offer some Medicaid dental benefits for adults, these benefits are often limited to specific segments of the population or cover only emergency care. Six states have taken significant steps to expand coverage this year: Hawaii, Tennessee, Kentucky, Michigan, Maryland, and New Hampshire.
Challenges Persist in Improving Access
One of the biggest hurdles is the reluctance of many dentists to treat Medicaid patients, particularly in rural areas. This results in long wait times and extensive travel for care. In New Hampshire, for instance, only about 15% of dentists accept Medicaid. Expanding Medicaid coverage can increase demand, but the slow process of getting dentists certified under Medicaid and inconsistent billing procedures pose challenges.
Low Medicaid Reimbursement Rates
Many dentists argue that low Medicaid reimbursement rates deter them from treating Medicaid patients. For example, New Jersey only covers 13.3% of what dentists typically charge. Illinois, New York, Ohio, and Oregon offer slightly higher reimbursement rates, but many states cover only 30-50% of private insurance rates. Only Alaska and North Dakota offer over 55%.
An Uphill Battle for Dental Access
The expanding dental coverage under Medicaid is certainly a positive step, but significant challenges remain. As millions of beneficiaries nationwide are being removed from Medicaid due to eligibility reviews, access to care is a growing concern. For many patients like Danielle Wilkes and June Renee Pentecost in Tennessee, it took a long journey and persistence to receive dental care through Medicaid. The relief is undeniable, yet the need for continued efforts to improve access to dental care is evident.
While progress is being made in expanding Medicaid dental coverage, the broader issue of dental access for all remains a crucial and complex challenge in many parts of the United States.
Erin Balsa is a highly skilled and knowledgeable health journalist with a passion for educating the public on important health and wellness topics. With extensive experience in both traditional and digital media, Erin has established herself as a trusted voice in the field.