- Email: [email protected]
Medicaid expansion and dentistry
Clinical Significance.—Dental professionals can contribute to the good health and future of the planet. The efforts to become eco-friendly may increase operating expenses and take some extra effort, but it is worthwhile. Dental hygienists may serve as leaders in the ecofriendly movement by talking to the dentist and co-workers about the possibilities, initiating a recycling program, or sharing green
product recommendations for items that the practice purchases.
Govoni M: Can dental hygiene be green? Dent Hygiene, Feb 2015, pp 24, 26 Reprints not available
Medicaid Medicaid expansion and dentistry Background.—The Affordable Care Act (ACA) expands Medicaid, which has the potential to significantly alter the dental benefits landscape. Before ADA, public health insurance coverage for children was growing, but because dental benefits for children are now mandatory under Medicaid and the Children’s Health Insurance Program (CHIP), 37% of US children have dental benefits through these agencies. Medicaid is no longer a program for lowincome-only patients with income eligibility in most states now many times the federal poverty level. For adults,
however, dental coverage is not required and Medicaid eligibility did not expand as it did for children. Private dental benefit coverage has been declining among adults, and this trend is expected to continue. However, Medicaid expansion under the ACA allows states to receive significant federal subsidies if they expand Medicaid eligibility for all low-income adults. As a result, Medicaid expansion is occurring rapidly. Even when states don’t expand Medicaid under the ACA, Medicaid rolls will expand because of enhanced enrollment efforts, called the woodwork effect. As a result
Fig.—The adult dental benefits expansion in select states. ACA, Affordable Care Act. Sources: The Henry j Kaiser Family Foundation4 and United States Department of Health & Human Services. (Courtesy of Vujicic M: The booming Medicaid market. J Am Dent Assoc 146:136138, 2015.)
182
Dental Abstracts
of the ACA, 2.6 million adults will gain dental benefits beyond emergency care. In addition, adult dental benefits are offered voluntarily through health insurance marketplaces where consumers can purchase private dental insurance. The 36 states for which data are available have a total of 1.1 million adults enrolled in private dental plans, with an expected 4.2 million who will gain dental benefits through Medicaid. Similar data are found in the 19 states where the Medicaid program provides some adult dental benefits (Fig). The Medicaid market is expected to grow faster than the private market even where Medicaid has not been expanded. Overall Dental Economy.—Dental care has been declining steadily among adults for a decade, which has led to a slowdown in dental care spending and stagnation in dentist earnings. These trends are not expected to change, with projected flat growth in dental care spending for several years. Only the Medicaid segment of the market will show substantial growth. Medicaid Expansion Targets.—Low-income adults have experienced the most significant decline in dental care over the past 10 years and are the group most likely to report avoiding or delaying needed dental care or to experience financial barriers to having dental care. Instead they visit emergency departments for dental emergencies. Low-income children are the group with the greatest increases in access to dental care recently. Dental care among US children is at its highest level ever. Distribution of Access.—Expanded coverage does not mean that the resultant expanded access is equally distributed. Policy issues that must be considered for Medicaid expansion to manifest in improved access include applying
good practices to improve access to Medicaid-covered patients, whether children or adults; introducing innovative dental care delivery models such as new types of dental care providers; and assessing the ability of the current dental care system to absorb large numbers of adults with newly acquired Medicaid dental benefits. Strong evidence supports the combination of patient education and outreach, streamlined administrative procedures, and enhanced provider incentives to promote Medicaid program success. Financial incentives still lag behind for adult Medicaid services. Evidence also shows the value of alternative providers such as community dental health coordinators. Finally, strong evidence indicates significant unused capacity in the current dental care system. However, Medicaid beneficiaries often find it difficult to locate a dentist who will care for them compared to persons with private dental benefits.
Clinical Significance.—Medicaid expansion provides a huge opportunity for dental care providers to meet the need for access to dental care for low-income adults. However, evidencebased Medicaid reforms should be implemented to take advantage of the opportunity and provide appropriate access to care and improved oral health in the targeted populations.
Vujicic M: The booming Medicaid market. J Am Dent Assoc 146:136138, 2015 Reprints available from M Vujicic, Health Policy Inst at the American Dental Association, 18th Flr, 211 E Chicago Ave, Chicago, IL 60611; e-mail: [email protected]
Volume 60
Issue 4
2015
183
product recommendations for items that the practice purchases.
Govoni M: Can dental hygiene be green? Dent Hygiene, Feb 2015, pp 24, 26 Reprints not available
Medicaid Medicaid expansion and dentistry Background.—The Affordable Care Act (ACA) expands Medicaid, which has the potential to significantly alter the dental benefits landscape. Before ADA, public health insurance coverage for children was growing, but because dental benefits for children are now mandatory under Medicaid and the Children’s Health Insurance Program (CHIP), 37% of US children have dental benefits through these agencies. Medicaid is no longer a program for lowincome-only patients with income eligibility in most states now many times the federal poverty level. For adults,
however, dental coverage is not required and Medicaid eligibility did not expand as it did for children. Private dental benefit coverage has been declining among adults, and this trend is expected to continue. However, Medicaid expansion under the ACA allows states to receive significant federal subsidies if they expand Medicaid eligibility for all low-income adults. As a result, Medicaid expansion is occurring rapidly. Even when states don’t expand Medicaid under the ACA, Medicaid rolls will expand because of enhanced enrollment efforts, called the woodwork effect. As a result
Fig.—The adult dental benefits expansion in select states. ACA, Affordable Care Act. Sources: The Henry j Kaiser Family Foundation4 and United States Department of Health & Human Services. (Courtesy of Vujicic M: The booming Medicaid market. J Am Dent Assoc 146:136138, 2015.)
182
Dental Abstracts
of the ACA, 2.6 million adults will gain dental benefits beyond emergency care. In addition, adult dental benefits are offered voluntarily through health insurance marketplaces where consumers can purchase private dental insurance. The 36 states for which data are available have a total of 1.1 million adults enrolled in private dental plans, with an expected 4.2 million who will gain dental benefits through Medicaid. Similar data are found in the 19 states where the Medicaid program provides some adult dental benefits (Fig). The Medicaid market is expected to grow faster than the private market even where Medicaid has not been expanded. Overall Dental Economy.—Dental care has been declining steadily among adults for a decade, which has led to a slowdown in dental care spending and stagnation in dentist earnings. These trends are not expected to change, with projected flat growth in dental care spending for several years. Only the Medicaid segment of the market will show substantial growth. Medicaid Expansion Targets.—Low-income adults have experienced the most significant decline in dental care over the past 10 years and are the group most likely to report avoiding or delaying needed dental care or to experience financial barriers to having dental care. Instead they visit emergency departments for dental emergencies. Low-income children are the group with the greatest increases in access to dental care recently. Dental care among US children is at its highest level ever. Distribution of Access.—Expanded coverage does not mean that the resultant expanded access is equally distributed. Policy issues that must be considered for Medicaid expansion to manifest in improved access include applying
good practices to improve access to Medicaid-covered patients, whether children or adults; introducing innovative dental care delivery models such as new types of dental care providers; and assessing the ability of the current dental care system to absorb large numbers of adults with newly acquired Medicaid dental benefits. Strong evidence supports the combination of patient education and outreach, streamlined administrative procedures, and enhanced provider incentives to promote Medicaid program success. Financial incentives still lag behind for adult Medicaid services. Evidence also shows the value of alternative providers such as community dental health coordinators. Finally, strong evidence indicates significant unused capacity in the current dental care system. However, Medicaid beneficiaries often find it difficult to locate a dentist who will care for them compared to persons with private dental benefits.
Clinical Significance.—Medicaid expansion provides a huge opportunity for dental care providers to meet the need for access to dental care for low-income adults. However, evidencebased Medicaid reforms should be implemented to take advantage of the opportunity and provide appropriate access to care and improved oral health in the targeted populations.
Vujicic M: The booming Medicaid market. J Am Dent Assoc 146:136138, 2015 Reprints available from M Vujicic, Health Policy Inst at the American Dental Association, 18th Flr, 211 E Chicago Ave, Chicago, IL 60611; e-mail: [email protected]
Volume 60
Issue 4
2015
183