More than 14 million adults across the United States who receive Medicaid are at risk of losing their dental coverage now that the public health emergency Covid iIt’s finishaccording to data exclusively obtained by NBC News.
The public health emergency ended April 1, allowing states to review the eligibility of Medicaid beneficiaries and opt them out of the program for the first time since the pandemic began. About 15.7 million people are expected to lose their health coverage as a result. The emergency declaration did not allow states to remove enrollees from the program during the pandemic, which has led to a precipitous expansion of programs over the past three years.
One problem few have identified, however, is that an estimated 14.2 million people, or 28% of adults currently enrolled in Medicaid, will also lose their dental health coverage, according to the data compiled by CareQuest Institute for Oral Healtha think tank dedicated to oral health in the country.
The five states facing the biggest drop in coverage are Hawaii, Wyoming, Indiana, Florida and Illinois. There are six states that don’t offer dental coverage as part of their Medicaid plans: Alabama, Delaware, Maine, Maryland, Tennessee, and Texas. State agencies are expected to make a huge push to deal with the re-determination of people’s eligibility for Medicaid.
Dr. Myechia Minter-Jordan, president and CEO of the think tank, said her group felt compelled to compile and publish the data to ensure that states and public health agencies help people to maintain their oral care coverage.
“As people are taken off Medicaid and seek coverage through other programs, including the private market, there is no guarantee that they will know how to find or know how to apply for coverage that will include the dental care,” she said. “And it will have a disproportionate impact on people with low incomes, living in rural areas or people of color.”
As many as 47 states offer some form of dental health coverage to Medicaid recipients, providing either emergency care, limited coverage, or expanded dental services. The loss of care could have an outsized effect on communities of color. About 25% of adults with Medicaid see a dentist each year, according to the Centers for Medicare and Medicaid Services, although it can be difficult to find a dentist who accepts Medicaid.
Those who are sounding the alarm on the issue cite numerous studies that link poor dental hygiene to a person’s overall health. These links have become a rallying cry for many in the dental world over the past few decades, as a landmark US Surgeon General study published in 2000 found that a person’s oral health could expose a person to a increased risk of health problems.
Beyond those risks, poor dental health can also affect a person’s self-image and ability to get work, said Dr. Lisa Simon, a physician and dentist at Brigham and Women’s Hospital and Harvard. School of Dental Medicine.
“It affects the way you feel, the way you communicate with others, your ability to feed yourself, the pain you feel every day, and perhaps your sense of yourself when you look in the mirror” , she said. “There is pretty good data showing that people who have less access to dental care, especially in childhood, often earn less money in adulthood because of how our appearance can affect our mental health and the perception others have of us.”
In the United States, dental health issues affect most adults. Only 48% of people aged 20 to 64 had a full set of permanent teeth, according to a 2015 study from the Centers for Disease Control and Prevention.
But preventative dental care can keep people out of the emergency room, saving patients, hospitals and states expensive emergency room care. However, states must balance this long-term cost savings with the potential immediate savings to state and federal budgets by significantly reducing dental coverage.
Medicaid and Children’s Medicare Program (CHIP) spending on dental services has increased from $14.9 billion in 2020 to $17.8 billion in 2021, according to the Centers for Medicare and Medicaid Services, although the amount spent on dental services relative to total Medicaid spending remained about the same – dropping only from 2.2% to 2.4%.
But people are also spending more on dental issues than ever before. Dental spending in the United States has grown from $95 billion in 2000 to $162 billion in 2021, according to the American Dental Association.
More than half was not paid by insurance companies in 2021, but rather by a combination of disbursements and additional government programs. Direct spending was about $63 billion in 2021 and government programs covered about $25 billion.
Yet a 2014 National Institutes of Health study found that dental benefit cuts during the 2008 recession led to increased use of emergency departments. And yet, it is often the first budget item that states consider cutting.
“States have only really expanded dental coverage in the recent past,” Simon said. “After the recession, there were huge cuts to Medicaid dental benefits, and in subsequent economic downturns, it’s often the first thing on the chopping block in state legislatures.”
The need is there. According to a CareQuest Institute report last year, 55% of adults reported some type of oral health problem, more than half of adults with a problem did not seek care and 27% did not did not seek care because they could not afford it.
Minter-Jordan said she hopes governments will be more proactive in ensuring there are opportunities to continue coverage, and she stressed that Medicaid recipients should check their coverage.
“We really want to make sure people understand — agencies, federal and state governments understand — the cost of not providing oral health care,” she said. “That’s really the key.”