Treating Pain Is Not Enough: Why States’ Emergency-Only Dental Benefits Fall Short
States have great latitude to determine the scope of dental benefits that they will cover for adults through their Medicaid programs. While some states cover comprehensive benefits, others cover emergency dental care only or none at all. This variation in coverage matters. Without adequate dental coverage, people face major barriers to getting care they need to stay healthy. To better understand the consequences of insufficient dental coverage, Families USA conducted a survey of states that cover emergency-only dental services.
In this issue brief we found:
- These states all cover limited services to address severe pain, generally including extractions. But most do not provide restorative care nor cleanings that would address underlying disease.
- In some states, Medicaid managed care plans provide plan-specific “value added” benefits.
- State Medicaid programs pay for expensive hospital emergency department visits when appropriate dental services are not available.
- More comprehensive benefits and fewer prior authorization requirements would encourage provider participation.
- Low-income seniors and people with disabilities who rely on Medicaid and Medicare for health coverage are among those affected by the lack of dental coverage.
Emergency-only dental coverage is better than nothing, but states should invest in comprehensive Medicaid dental coverage for adults if they want to effectively keep their populations healthier and reduce other health care costs.