Fifty years ago on July 30, President Lyndon B. Johnson signed legislation to create Medicaid, a revolutionary program to provide health care to people who otherwise couldn’t afford it. In the ensuing half century, Medicaid has improved tens of millions of lives.
With the passage of the Affordable Care Act, Congress, the president and the states have extended Medicaid even further. Today, the combination of poverty, high unemployment and low-wage jobs makes Medicaid more critical than ever. By one account, nearly two-thirds of Americans have either benefited directly from Medicaid or have a family member or friend who has.
The federally mandated Early and Periodic Screening, Diagnostic and Treatment (EPSDT) provision requires states to cover comprehensive dental care for Medicaid-enrolled children. In some states these kids receive dental care at rates equivalent to those covered by private insurance. But most state Medicaid dental programs fail to provide adequate care, especially to adults. Many state Medicaid programs allocate less than 1 percent of their budgets for dental services.
This owes in large part to underfunding and poor administration. According to the American Dental Association Health Policy Institute (HPI), Medicaid fees for pediatric dental services in 2013 ranged from a low of 29 percent of market rates for the same procedures (California) to a high of 81 percent of market rates (Delaware). Overhead for dental offices in many cases is significantly greater than Medicaid reimbursement rates, meaning that in many states, dentists might lose money caring for Medicaid-enrolled patients.
Initial credentialing to qualify as a Medicaid provider can take months, and excessive administrative burdens are additional disincentives for dentists who might otherwise participate in the program.
As a result, only 39.5 percent of publicly insured children in our country saw a dentist in 2012. And while this represents an upward trend, progress is too slow. Too many kids continue to suffer with painful disease.
The situation is worse for low-income adults. Unfortunately, budget-strapped state legislatures tend to think of dental care as expendable. Many state Medicaid programs do not offer adult dental benefits or only cover a limited number of services.
The results are dismaying. In 2012, only 20.5 percent of adults covered by public programs like Medicaid saw a dentist, a 20-percent decline since 2000. Not surprisingly, emergency room visits for dental pain are rising among low-income adults. These costly ER visits do not address the underlying problem, as most ERs are not able to treat basic dental emergencies.
Here in Connecticut, our Medicaid program, HUSKY, is looked at as a leader in Medicaid dental programs. With efforts to increase reimbursement rates and eliminate administrative hurdles, we were able to transform the program, increasing dentist participating from less than 200 in 2008, to more than 1,800 in 2013. As a result, Connecticut has the second highest Medicaid utilization among children, with no child waiting more than 24 hours for a dental emergency.
That being said, Connecticut still has a lot of room for improvement, especially for adult dental care. When it comes to the Connecticut state budget, dental Medicaid continues to be on the chopping-block, and without adequate funding, many Connecticut citizens will seek more costly emergency care.
The congressional EPSDT mandate, along with proven innovations in adult programs in forward-looking states like Connecticut, have proven that we can put good oral health within reach of the most vulnerable. The state of dental care in Medicaid is far from perfect, but it has worked for millions and can work for millions more. We should celebrate the program on its 50th birthday and commit to doubling down on dental care.
Dr. William Nash is president of the Connecticut State Dental Association.