Many states are expanding Medicaid programs to provide dental care to poorer residents

For months, Carlton Clemons endured crippling pain from a rotting wisdom tooth. He couldn’t sleep, barely ate and relied on painkillers to cope.

The 67-year-old from Nashville, Tennessee, couldn’t afford to see a dentist on the $1,300 a month his family receives in Social Security and disability payments. So he waited for the state to launch a program this year that provides dental care to more than 650,000 Medicaid recipients who are 21 and older. Tennessee is spending about $75 million a year on the program.

“Man, I thought I had reached heaven because the pain was gone,” he said after the tooth was pulled in July at Meharry Medical College School of Dentistry. “When they took it out, I was very happy. I was very happy. Everything changed only after that.”

His wife, Cindy, who is also on Medicaid, had her teeth pulled at the clinic.

Medicaid, the federal and state health insurance program for the poor, requires states to provide dental coverage to children but not to adults. But with a growing recognition of the economic and health costs of poor dental health and an influx of federal pandemic dollars, six states started or expanded their Medicaid programs this year to provide coverage for adults.

Access remains difficult in many of those states with some dentists refusing to treat Medicaid patients. Even those who want to expand their practice are finding themselves caught up in red tape.

Dr. Victor Wu, chief medical officer for Tennessee’s Medicaid program, said he was pleased with the rollout of Medicaid dental benefits that began in January, but he admits the state needs to build its network and increase participation rates among dentists.

While dental care is often seen as routine, the poor often go without care for years or even decades. Doing so comes at a significant cost, both to taxpayers and to those who cannot afford treatment.

A study from Texas A&M University found that treatment for preventable dental conditions represents up to 2.5% of emergency room visits, at a cost of $2 billion annually. According to the federal Centers for Disease Control and Prevention, an additional $45 billion is lost in productivity in the United States each year from untreated oral diseases.

“You put off care and get sicker and then it becomes a crisis where you miss work or end up going to the emergency department where you get a big bill and don’t get the tooth taken care of.” said Dr. Rhonda Switzer-Nadasdi, chief executive officer of Interfaith Dental Clinic, which has offices in Nashville and Murfreesboro, Tennessee.

“You need good teeth to get a good job,” Switzer-Nadasdi said.

RELATED: What Dental Services Will Florida Medicaid Cover?

All states offer some Medicaid dental benefits for adults, but some limit it to specific segments of the population, such as pregnant women or those with intellectual disabilities, or cover only emergency care, according to the CareQuest Institute for Oral Health. a nonprofit organization that advocates for expanded dental care.

Hawaii, Tennessee, Kentucky, Michigan, Maryland and New Hampshire were the latest to start or expand their dental coverage; they did it this year.

In New Hampshire, the state is spending $33.4 million over 12 months to provide dental care to its 88,000 Medicaid recipients.

“There is a growing understanding that oral health is inseparable from health care,” said Democratic New Hampshire Rep. Joe Schapiro, who was the lead sponsor of the expanded dental benefits bill. “The amount of money spent on other health care problems related to oral health and the amount of money spent on emergency care when people can’t get any kind of preventive or restorative care is not only unfortunate for health. of those people, but it costs a huge amount of money.”

In Kentucky, Democratic Gov. Andy Beshear pressed ahead with emergency regulations ensuring that about 900,000 Kentuckians will continue to have access to dental care after the Republican-led legislature rejected his proposal.

“We’re focused on removing the barriers that keep people from getting back into the workforce, and this program does just that,” he said.

Virginia expanded its Medicaid program in 2021, budgeting $282 million for fiscal years 2022 and 2023 to cover dental procedures for more than one million recipients. Last year, Kansas provided dental access to nearly 137,000 Medicaid recipients at a cost of $3.5 million in 2022 and $1.2 million in 2023.

While advocates are welcoming these changes, Texas, Alabama, Mississippi, Utah and Louisiana still offer only limited benefits.

Even as states add dental coverage, millions of beneficiaries are being dropped from the Medicaid program nationwide as part of an eligibility review, something states were barred from doing during the pandemic.

There are also many hiccups in states that have expanded care, including Tennessee. Among the biggest is that too few dentists, especially in rural areas, are taking Medicaid patients, resulting in long wait times and hours-long commutes in search of care. Only about 15% of dentists receive Medicaid in New Hampshire, 24% in Tennessee and 27% in Virginia.

Many dentists and groups advocating for expanded care blame Medicaid reimbursement rates. New Jersey covers just 13.3% of what a dentist would normally pay, Michigan covers 17% and Rhode Island 22.4%, according to 2022 data analyzed by the American Dental Association. Illinois, New York, Ohio and Oregon each cover just over 28%.

However, most states cover between 30% and 50% with Alaska and North Dakota covering at least 55% and Delaware, 76.9%.

Heather Taylor, an assistant professor at Indiana University’s Richard M. Fairbanks School of Public Health, said some of Indiana’s Medicaid reimbursement rates for dental have not increased since 1998.

“It’s almost like we’re encouraging our dentists not to treat those in need because we’re not paying them half of what they could get from private insurers,” she said.

Tennessee Family Dental, which has four clinics in the state, has experienced high demand from Medicaid patients. Dr. Ryan O’Neill, a dentist who owns the business, said he received about 300 calls the first day and that some of his patients have traveled from 30 minutes or more.

He wants to hire more dentists, but said it could take more than four months to get one certified under Medicaid. He’s also struggling with a Medicaid billing system that routinely rejects some claims, and he said there’s “a lot of inconsistency over what gets approved and what gets denied.”

“Offices are reluctant to go online because there are so many unknowns,” O’Neill said. “We’re still learning what the rules are and, you know, trial and error as to how we should deal with a particular situation.”

Danielle Wilkes, a 26-year-old mother of five from Ashland, Tennessee, drove 90 minutes to see O’Neill after calling dozens of dentists in her area and finding none that took Medicaid. Her cousin, June Renee Pentecost, came with her for treatment.

For the past five years, Wilkes had been waiting to see a dentist after several teeth were knocked out in a car accident. She was told it would cost her thousands of dollars for multiple crowns, which she could not afford.

“I was mad at first but I was like there’s nothing he can do. I’ll just have to wait until my kids are grown,” she said, adding that the pain often reduced her to tears.

But there she was in a dental chair, her pink hair standing out against O’Neill and dental assistant Jasmine Webb in black scrubs. Afterward, the soft-spoken Wilkes said she was “just happy” to finally get the job done, even if she had to pay $400 that Medicaid didn’t cover.

In another room, Pentecost was being examined for a root canal. It had been more than a decade since she last visited a dentist because she was deterred by the cost despite years of pain. A mother of five, she thought dental care would keep the costs down for her children.

“I couldn’t play with my children because my head hurt,” she said.

The 30-year-old was relieved when he finished work, but wondered why the state hadn’t offered the benefit sooner.

“I’m hoping that my pain will ease up and stop once I get my teeth fixed and then I won’t have so many headaches and I won’t feel so bad,” she said.

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