Reform Update: ACA means dental care for millions on Medicaid

Expanded Medicaid coverage under the Patient Protection and Affordable Care Act means millions of adults will get access to dental services, in many cases for the first time.

As many as 8.3 million Medicaid beneficiaries will become eligible for dental benefits this year, according to an analysis by the American Dental Association. The trade group estimated that 2.9 million Americans will gain comprehensive dental benefits and 5.4 million will gain limited dental benefits. Officials in states that are adding the coverage expect it save them substantial sums on emergency department visits.

Colorado began giving adults dental benefits for the first time on April 1. Residents enrolled in the program ages 21 and older now have access to preventive services like cleanings, minor fillings and diagnostic imaging services. As of July 1, they will be eligible for more comprehensive services such as root canals, crowns, partial dentures, periodontal scaling and root planing.

The new federal funding under the Affordable Care Act also allowed Washington state to restore the benefit to adults on Jan. 1 after budget woes forced it to cancel dental coverage in 2011. California, Massachusetts and Idaho likewise are restoring adult dental benefits this year.

Emergency department visits for dental conditions have doubled over the past decade, costing the healthcare system up to $2 billion per year, according to the ADA.

Without dental coverage, Medicaid beneficiaries often wait until their conditions are severe and end up in the ED, which in most cases can only provide antibiotics or painkillers. Patients then end up returning to the ED every few weeks, unless they are able to get treatment for the underlying problem at a federally qualified community health center or from a dentist volunteering services through a charity.

“We ended up paying for care in the most expensive setting possible,” said Nathan Johnson, director of policy, planning and performance for Washington state's Health Care Authority.

While rare, not having access to dental coverage can result in death, noted Dr. Brent Martin, dental director for MassHealth, the agency that administers the state's Medicaid program. A 2010 study identified a link between gum disease in pregnant mothers and stillbirth. In 2011, a 24-year-old Ohio man died from a tooth infection that spread to his brain after he was unable to afford both the painkillers and antibiotics prescribed for his toothache in the ED. He only filled the painkiller prescription.

“It's sad because it was so preventable,” Martin said.

Adequate dental care can also mean the difference between a beneficiary getting a job or not. “Having missing or decayed teeth, especially if they are in the front, make it difficult to maintain one's appearance and impacts the ability to compete for jobs,” said Andrew Snyder, a program manager at the National Academy for State Health Policy.

Children already receive comprehensive dental benefits in Medicaid or CHIP programs in all states, and dentists hope that expanded access to dental care for adults will lead to better dental hygiene among children. “Parents have a direct influence over their children, if their parents are receiving regular care, it will hopefully influence children to brush and floss, which will keep them from getting a dental disease,” said ADA President Dr. Charles Norman.

The ADA warns, however, that expanded coverage does not guarantee that dental offices will be busier however . The group is pushing states to reach out to Medicaid beneficiaries and dental care providers to make them aware of the benefit. The ADA is also encouraging states to streamline administrative procedures and increase reimbursement rates to make it more appealing for providers to participate.

A federal judge blocked a move by Louisiana Gov. Bobby Jindal's administration to have the liberal advocacy group MoveOn.org take down billboards over his decision to not expand Medicaid.

MoveOn used the state's tourism tagline “Pick Your Passion” in a billboard that criticized the state's decision to not expand Medicaid to 242,000 of its residents. The Republican governor's administration sought an injunction claiming MoveOn.org improperly mimicked the state's trade and tourism branding.

U.S. District Court Judge Shelly Dick disagreed on Monday, citing the group's free speech rights.

“The state has failed to demonstrate a compelling reason to curtail MoveOn.org's political speech in favor of protecting of the state's service mark,” Dick says in her ruling. She added “irreparable injury” would not be caused to Louisiana's tourism campaign if the ad remained in place.

The administration has not yet decided whether to appeal the ruling.

A group of researchers posing as patients made 13,000 calls to primary-care practices in several states to see how hard it would be to get an appointment for people with new insurance coverage under the healthcare reform law. The answer depended on what kind of coverage.

When researchers said they had private insurance, they were able to make an appointment about 85% the time. However, those posing as Medicaid patients were successful about 60% of the time, even though they contacted only providers listed as accepting Medicaid. The study was published April 7 in JAMA Internal Medicine.

Follow Virgil Dickson on Twitter: @MHvdickson