Alternative Headline: Dental Coverage Saves Lives, Cuts Costs
[MM Curator Summary]: Medicaid dental reforms, sparked by a preventable child’s death, now save lives, reduce costs, and support employment.
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In 2007, the Maryland 12-year-old had an abscessed tooth, but his mother could not find a dentist who would accept Medicaid to complete the $80 extraction. The infection reached his brain. Two neurosurgeries could not save him.
Driver’s death spurred the General Assembly to increase Medicaid reimbursement so more dentists could afford to offer care to patients like him, among other steps aimed at children, Maryland Sen. Malcolm Augustine (D) told NCSL’s “Our American States” podcast.
“This was an absolutely preventable loss of life that with just basic dental care. We would have been able to save young Deamonte’s life,” Augustine says. “And that touched the hearts of the people of our state and really moved us in a direction to really improve and expand dental coverage for children.”
Within five years, the state was ranked by The Pew Charitable Trusts as one of the best at providing dental care to children on Medicaid. Augustine went on to introduce a successful bill to give dental coverage to adults on Medicaid as well.
“A significant number of our emergency room visits were patients who were there for dental services,” Augustine says. “As one of the few states that did not offer a comprehensive dental care plan (for adults), we realized that this was actually costing us a significant amount of money.”
While Medicaid does not require adult dental care, 47 states offer some coverage. Still, the American Dental Association estimates the coverage falls far short of the need. Expanded dental care could not only prevent a death like Driver’s, but also improve overall health and save states money, says Ian Hedges, the association’s director of Medicaid and Medicare program policy.
“There is research that suggests heart disease, clogged arteries and stroke might be linked to the inflammation infection that oral germs can cause,” he says. “We know gum disease among pregnant women has been linked to premature birth and low birth weights,” and diabetes is linked to poor dental health. People who don’t get regular care often wind up in costly emergency care when dental problems become unbearable, he adds.
An association study found that emergency rooms treated 2.1 million patients with dental conditions in 2017 at a cost of $2.1 billion.
“One study found that untreated oral health conditions can lead to health complications that cost the U.S. about $45 billion each year in lost productivity,” Hedges says, adding that it can even affect employment opportunities.
Connection to Health and Employment
“There is well-documented evidence showing that poor oral health not only affects your overall health, but it can play a determinant role in whether someone is to be gainfully employed,” he says.
Hedges recalls seeing that firsthand when he ran a health clinic.
“I remember numerous stories of patients who were working part-time fast food jobs making $12 to $13 per hour. But as soon as they got a new smile or even getting cavities treated in their front teeth, many of them would not have to utilize our clinic anymore because they got a $24 to $25 per hour customer service job with benefits,” he says.
Utah Sen. Evan Vickers (R) gained bipartisan support last year for a bill to offer dental coverage for all adults on Medicaid.
Vickers says Utah partnered with a growing program at a dental school founded only 10 years ago, the University of Utah School of Dentistry. The partnership expands coverage to over 120,000 adults for services including checkups, cleanings, fillings, root canals and dentures.
“They started out small. They used their endowment that they originally had at the dental school to provide coverage for the blind and disabled and those suffering under substance abuse,” Vickers says. The school later added coverage for the elderly.
The school also began building a network of dentists across the state who would accept Medicaid patients and eventually got a federal waiver to increase Medicaid reimbursements using its endowment, he says.
With Vickers’ bill, the state was able to cover all adults who were not previously covered under another program.
“If you can take care of a patient at the lower-level entry challenges,” Vickers says, “then you could prevent it from escalating into something that turns very serious and very expensive to the state later on.”
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