By Maxine Feinberg Recently, our nation commemorated the 50th anniversary of Medicaid, the federal-state health care program that serves nearly 60 million Americans. In the half century since President Lyndon B. Johnson signed Medicaid into law, it has helped to transform the American health care system, providing access to care to many of our most vulnerable friends, neighbors and family members.
But Congress left out a key component of good health care – dental care. While dental coverage is part of the Medicaid benefit package for children, it is optional for adults and many people on Medicaid suffer from poor oral health. It is time to close that gap.
Good oral health is integral to good overall health. But despite Medicaid’s assistance, for too many Americans, access to dental care is limited by skimpy coverage. People who don’t get good dental care often live with infections that can spread to other parts of their bodies. Children miss more than 51 million school hours each year due to dental-related illness for a condition that could be treated earlier or prevented in the first place if appropriate resources were available. Untreated dental problems also cost taxpayers billions with more than 2 million people going to emergency rooms each year for dental care.
Medicaid offers a lifeline of support and access to care. But when it comes to dental care, many states do far too little to ensure access. The Medicaid statute requires state payments to be sufficient to enlist enough providers so that care and services are available to at least the extent that they are available to the general population in the geographic area.
Yet the average state Medicaid program spends less than 2 percent of its budget on dental services. Dental benefits vary widely, with some states offering coverage akin to private dental benefits and others offering no dental benefits at all. Payment rates are often very low, which discourages participation and reduces access. For example, in Illinois, Medicaid pays dentists just under 14 percent of what commercial insurers pay for the exact same care. Some states force dentists to wade through reams of red tape before they can care for patients. In one state, it took an average of one year for a dentist to be approved to treat Medicaid patients.
Earlier this year, the Supreme Court dealt a blow to efforts by the American Dental Association and others to expand access to affordable care for low-income Americans. In a 5-4 decision, the court said that health care providers cannot go to court to challenge inadequate Medicaid payment rates that deter physicians, dentists and others from caring for patients in need. The ADA filed a friend of the court brief in the case because of the injury we have seen low payment rates cause to vulnerable patients. Now that the court has ruled, states have an even greater responsibility to protect access to care for low-income citizens.
There is growing evidence that a few simple reforms can go a long way to fixing Medicaid. States like Connecticut have reduced and simplified their Medicaid paperwork requirements while increasing dental funding to a modest 2.4 percent of their Medicaid budget. The results, as reported by the Connecticut Department of Public Health, include a more than 1,000 percent increase in the number of participating dentists, a jump in the percentage of Medicaid-eligible children receiving dental treatment from 37 to 62 percent and the incidence of untreated and severe caries — the dental disease which causes cavities — dropped 50 percent..
Unfortunately, many states have yet to realize that putting patients first can deliver better health and big budget savings at a time when most health budgets are under severe strain. The ADA will continue to fight for Medicaid reform on behalf of patients in need.
Congress should pass the bipartisan Action for Dental Health Act 2015 (HR 539), which aims to reduce the number of people who visit the emergency room for dental conditions, expand access to dental care for people in nursing homes, support charitable programs that provide care to disadvantaged children and adults and ensure more Americans have access to drinking water with fluoride. The bill, which has 64 sponsors, redirects existing resources to programs that reduce and eliminate barriers preventing millions of Americans from achieving good oral health.
More access to preventive dental care for Americans in need is within reach. Proven solutions are there, as are huge potential budget savings. This is evidence that state leaders can’t ignore.
Maxine Feinberg, DDS is president of the American Dental Association.