Content Dam Diq Online Articles 2015 06 Medicare 1

What’s next for Medicaid and Medicare when it comes to dental benefits?

July 31, 2015
Medicare and Medicaid have made great strides during their 50-year existence, but there is still room for improvement, especially when it comes to dental benefits. Many people still end up in the emergency room for lack of any other access.

Editor’s Note: In this update about Medicare and Medicaid, Chief Dental Officer of DentaQuest, Dr. John Luther, calls on his peers to take action. “Access to dental care should not be a function of age or income. We cannot rest on the achievements made for children’s oral health. We must continually strive for oral health equity for all,” he states.

On the day Medicare and Medicaid were created, President Lyndon B. Johnson spoke of a shared tradition that “directs us never to ignore or to spurn those who suffer untended in a land that is bursting with abundance.” As we celebrate the 50th anniversary of these vital health-care programs, President Johnson’s words still ring true, especially as we consider what the next 50 years will bring. Medicare and Medicaid were intended to provide basic health insurance to low-income, vulnerable Americans. Both were created on the premise that health coverage contributes to better health outcomes, and this fact is as true today as it was in 1965. Before the creation of Medicare, only half of all seniors in the U.S. had health coverage and of those with coverage, the benefits were not sufficient to meet their health care needs. Today, Medicare covers 54 million people – nearly all seniors nationwide – and offers a broad scope of services. After its first year, the Medicaid program covered about 2% of the population. Then in 1967, Congress enhanced Medicaid coverage for children by mandating Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services for enrollees under age 21. EPSDT was created to provide comprehensive medical, dental, mental health and developmental health care services to prevent disease and ensure that low-income children could live healthy lives. Today, the Medicaid program serves as a vital source of health and financial security to nearly 70 million children, pregnant women, people with disabilities, and working men and women.

With the introduction of the Children’s Health Insurance Program (CHIP), Medicaid has continued to be a driving force in reducing the uninsured rate among children. Between 1997 and 2012, the percent of uninsured children in the U.S. was cut in half. Today, 33 million kids – one in three kids – are getting a healthy start as Medicaid enrollees.

Here are a few examples that illustrate the importance of these programs and the significant strides some states have made when it comes to children and preventive oral health care. In Massachusetts, the Medicaid dental provider network has grown by 78% since 2007. Idaho has increased the number of EPSDT-eligible children receiving dental care and exceeds the national average at 56%. In Texas a successful prevention-focused program offers incentives to providers for ensuring their patients get recommended preventive services.

While we can laud Medicaid for its role in the significant improvements we’ve seen with children’s oral health, the same cannot be said for adults. Although Medicaid covers one in five non-elderly Americans, only 15 state Medicaid programs offer comprehensive oral health coverage to adults. In addition to the millions of adult Medicaid enrollees, 70% of Americans over the age of 65 do not have dental coverage.

Lacking a consistent source of care, low-income adults suffer disproportionately from dental disease. Forty-two percent of low-income adults between the ages of 20 to 64 are walking around with untreated oral disease and are often in significant pain. For those over age 65, the statistics are even more bleak. More than one-third of those 65 or older have lost all of their teeth.

Along with age, we know that inequities associated with ethnicity, income, and geography result in worse health outcomes for those without access to care. It’s no surprise then that African-Americans and Hispanic-Americans experience untreated tooth decay nearly twice as much as Caucasian Americans, and 70% of older Americans have periodontal disease. Disparities in health are exacerbated for those with untreated dental disease suffering from chronic conditions like diabetes and heart disease.

Without consistent dental care, many people turn to emergency departments (ED) when dental problems become too painful. Most EDs are not equipped to provide dental services, so patients are often simply given painkillers and sent on their way. Because the underlying dental issue is not being addressed, 39% of these patients return to the ED. An estimated 80% of dental-related ED visits – which cost the health care system three times as much as a dental office visit – are due to conditions that are completely preventable if caught early. While efforts to redirect those seeking care in an ED to a primary source of dental care have seen positive results, the fact remains that without a consistent source of coverage many adults still have no other option.

Access to dental care should not be a function of age or income. We cannot rest on the achievements made for children’s oral health. We must continually strive for oral health equity for all.

As oral health clinicians, we call on our leaders at the national and state level to act now to ensure dental coverage for adults served by Medicare and Medicaid. To do less would be a disservice to the spirit in which the Medicare and Medicaid programs were created. As President Johnson said in 1965, “We are a land bursting with abundance and we cannot let millions suffer untended.”

Dr. John Luther serves as DentaQuest’s Chief Dental Officer and Senior Vice President of Dental Management, with overarching responsibilities for managing DentaQuest’s dental networks across the country and for the clinical practices, quality standards, and procedures for the enterprise. His interests are focused on quality improvement and cost reduction through medical-dental integration, education, oral health literacy, patient risk management, and disease prevention. Dr. Luther previously served as Chief Dental Officer for United Healthcare as well as Senior Vice President, Division of Dental Practice, for the American Dental Association. He began his career in private-practice dentistry in California.