Analyzing Medicaid expansion and dental benefits

Every day we interact with diverse patients in the clinic, we are obligated to provide the best treatment possible to those we serve. Many of us have worked with patients enrolled in Medicaid and have seen first-hand how big an impact it can have on someone’s oral health. In May, my colleague, Districts 10 & 11 Legislative Coordinator Walter Fuentes, wrote about the funding implications for Medicaid if the Affordable Care Act (ACA) is repealed and replaced. I would like to share with you more about how this could affect Medicaid expansion.

What is Medicaid expansion?
For those less familiar, Medicaid is widely known as the government-funded healthcare program that has provided low-income families with health-related services since the 1960s. The Affordable Care Act expanded eligibility requirements to include individuals slightly above the poverty line. The landmark 2012 Supreme Court Ruling National Federation of Independent Business v. Sebelius revised this eligibility requirement by recognizing states’ rights to choose if they participate in Medicaid expansion. In response to the decision, thirty-one states and the District of Columbia chose to take part. For the current status of state Medicaid expansion decisions, click here.

What does Medicaid expansion mean for dentistry?
Comprehensive dental coverage is mandatory for children enrolled in Medicaid, but dental benefits for adults are optional. This has caused many states to limit coverage only to emergency dental services for adult patients.

For states that have expanded their Medicaid coverage, the federal government subsidizes the majority of costs associated with providing care to newly eligible individuals. This has led several states to re-examine the dental benefits they currently provide to low-income adults.

Some states have made good use of funding. California, Colorado and Ohio are just a few of the states that added adult dental benefits through Medicaid expansion.

California reinstated a program called Denti-cal in 2014, which extended their Medicaid services to include a variety of dental services for adults. Covered services include exams and X-rays, cleanings, fluoride treatments, fillings, anterior root canals, prefabricated crowns and full dentures. The Medicaid expansion allowed nearly 1.3 million more people to reap the benefits of the Denti-cal program in California, bringing the total number of recipients to 10 million people in 2015.

Similar results can be seen in Colorado. A research study from the Colorado Health Institute showed that eligibility for Medicaid dental services in Colorado increased threefold, with almost one million enrolled.

These innovative strategies that take advantage of federal funding to increase access to care for low-income families have set the foundation for a big change in dental care.

What are the issues with Medicaid expansion?
While access to care is of high priority, unfortunately it doesn’t always lead to a dental visit. According to a recent ADA article, researchers saw mixed signals when looking at the frequency of dental visits for the adult Medicaid population. They found that in states that had expanded their Medicaid program, “childless adults had a significant increase in the likelihood of having a dental visit, while low-income parents had a significant decline.”

Without increasing the reimbursement rates for Medicaid providers, eligible patients may not be able to see a dentist. Kaiser Health News reported in 2015 that “many dentists are reluctant to participate in the government program for low-income Americans because it typically pays as little as half of what they get from patients with private insurance.” With large increases in Medicaid enrollment after the expansion, it is important to make sure coverage turns into care and that there are proportional increases in the number of dental providers willing to treat Medicaid patients.

What is the future of Medicaid Expansion?
We’ve seen how states have been able to provide additional adult dental benefits by taking advantage of funding through Medicaid expansion.

While there are issues that need to be addressed, the American Dental Association predicted that approximately 5.4 million adults gained dental benefits from the Medicaid expansion. This is an vital step in reducing barriers to dental care. Both the Senate and House of Representatives health care reform bills call for phasing out the Medicaid expansion program. It is important to understand how this may affect dental care for low-income adults in your state and how that will affect the future of your practice.

 

~ Steven Erbeck, New York ’20, legislative coordinator, Districts 1-3