A dozen states currently do not provide Medicaid dental coverage to adults with intellectual and developmental disabilities, while some others cover only emergency care. A new study from the National Commission on Disability (NCD) spells out the need for Medicaid adult dental benefits for those with I/DD, and argues that those states without such benefits should move to extend coverage immediately.
NCD’s report titled “Medicaid Oral Health Coverage for Adults with Intellectual & Developmental Disabilities – A Fiscal Analysis” highlights the proven link between oral health and a person’s overall health, as well as the importance of oral healthcare to individuals with I/DD. Medicaid plays a critical role in determining what care is available to the 60 percent of patients with I/DD who receive healthcare coverage through their state’s Medicaid program, according to the report.
This report was motivated by a central research question: should the Centers for Medicare and Medicaid Services require all state Medicaid agencies to implement Medicaid reimbursement and payment policies that promote access to dental care for adults with I/DD, and would do so be cost- effective over the long term?
The report finds that the answer is “absolutely yes” to both questions. Because Medicaid adult dental benefits vary widely by state, and because there is a dearth of research on how the Medicaid program should best address oral health disparities for adults with I/DD, this report examined the relationship between states’ Medicaid dental benefits and the receipt of basic dental care among adults with I/DD; the relationship between state waiver programs and receipt of dental care; and the estimated cost and potential savings of implementing basic dental Medicaid benefits in states that do not currently offer it. Additionally, this study examined the role of coordination between Developmental Disability agencies and Medicaid agencies for improving access to dental care. Finally, the study identified promising Medicaid-funded state and private strategies for expanding dental care for adults with I/DD.
Key findings include that in the 12 states that do not currently provide dental benefits, the total estimated cost of providing extensive dental benefits to adults with I/DD would be approximately $19.6 million annually, with those state government’s responsible for approximately $7.3 million of that cost . NCD estimates that these costs would be more than fully recovered through reductions in emergency department use and hospital admissions and reductions in the cost of treating several chronic diseases the root cause of which are poor oral health. The researchers estimate federal and state governments combined would realize a return on investment (ROI) of approximately $7.7 million beyond recovering the initial cost, annually, and the share of that ROI for those 12 states would total close to $3 million, annually.
The report notes that recent state-level research suggests that providing adults with dental benefits through Medicaid reduces overall Medicaid costs for states. However, even in states that provide dental benefits in Medicaid, people with I/DD still face barriers to receiving care, in part because of the lack of dental providers who participate in Medicaid who can treat adults with I/DD. Prior research has shown that increasing Medicaid reimbursement rates for physicians increased access to medical care among all adult Medicaid beneficiaries. Prior research has also demonstrated that increasing Medicaid reimbursements for dental providers increased receipt of dental care among children. However, prior research has not examined whether increased dental reimbursement rates increased the availability of dental care for adult Medicaid beneficiaries with I/DD.
Steve Pollock, president and CEO for Medicaid dental benefits administrator DentaQuest, issued the following statement reacting to the NCD report: “This new report makes clear that oral healthcare is healthcare and investing in dental benefits is the fiscally and ethically responsible move. Without routine dental visits, dental disease or pain can go untreated, particularly among people with I/DD who may have difficulty communicating. This report proves that providing Medicaid dental benefits for adults with I/DD—60 percent of whom rely on Medicaid for their health coverage—is more cost-effective than continuing to exclude those benefits. It is also more ethical — coverage would address a significant disparity in care, reduce chronic pain, improve quality of life and bolster self-confidence. And an adult dental Medicaid benefit directly addresses a key gap in health equity for other populations, as well.”