A number of 1115 waiver elements affect access to oral health care. Some waivers directly mention oral health, as part of wellness programs that might be paired with health savings accounts, or by requiring enrollees to pay monthly contributions for dental coverage. In states with these wellness programs, adults must adhere to a schedule of dental visits or other wellness activities to earn or retain dental benefits. In some of the states, adults accumulate money in a health savings account, partly by engaging in specified “healthy behaviors”, which they can then use to buy dental benefits. Other state waivers propose to charge monthly contributions for adult dental benefits or put enrollees into private market plans that may not cover dental, requiring them to purchase additional coverage or go without it.
In addition, many waivers that do not directly mention dental benefits will still curtail access to oral health care by cutting people off of Medicaid entirely or making it more difficult for them to retain coverage. For example, waivers with work requirements will make it harder for low-income people to enroll and maintain Medicaid coverage, thus restricting their access to dental benefits.
For more info, see: