Congress Shows Support for Medically Necessary Dental Care

We’re advancing toward oral health coverage in Medicare, one small step at a time

Millions of seniors and people with disabilities rely on Medicare for their health care, but it does not cover their oral health care. Even if someone needs dental care in order to have a medical procedure—like a kidney transplant patient who needs an oral infection treated to begin surgery — Medicare won’t cover the oral health care. Luckily, coverage of “medically necessary” dental care could be added to Medicare through CMS’s administrative authority fairly easily without any need for legislation.

At the end of last week, key bipartisan members of the House and Senate sent letters to the Center for Medicare and Medicaid Services (CMS) asking to it cover certain “medically necessary” dental care in Medicare. 43 House Representatives and 28 Senators signed these bipartisan letters. This is an important show of support for an issue that rarely gets the attention it deserves from policymakers.

Representatives Gus Bilirakis (R-FL) and Sandy Levin (D-MI) led the sign-on effort in the House, while Senators Rand Paul (R-KY), Ben-Cardin (D-MD) and Debbie Stabenow (D-MI) shepherded the effort in the Senate. The letters ask the administration to assure seniors and people with disabilities can get the dental care they need to be covered by Medicare so they can address other serious health issues.<

These letters are a great step toward raising the profile of seniors’ and people with disabilities’ oral health needs and improving coverage. A CMS decision could provide some level of oral health coverage for people who currently have absolutely none.

Progress on medically necessary oral health care now sits with CMS

Now that these key lawmakers have signaled their support to CMS, the next phase of this effort will be to ensure that the administration pays attention to and acts on this issue. Luckily, there are a number of reasons for CMS to engage on medically necessary dental care.

First, this coverage fits squarely within CMS’s priorities. It is a solution that both improves health outcomes and reduces overall health care costs. The value of medically necessary oral health coverage is demonstrated through a large body of clinical research and real-world examples from Medicare Advantage, Veterans Affairs, and private insurance plans showing the impact of medically necessary oral health coverage on addressing health needs and reducing health care costs.

Furthermore, this issue is very well supported. There is a strong coalition behind this effort, including Families USA, Justice in Aging, Center for Medicare Advocacy, Oral Health America, Pacific Dental Services, American Dental Association, American Dental Hygienist Association, and others. Dozens of consumer, oral health, and health care organizations have signed the community statement supporting this effort. The public is also supportive of this effort. A recent Morning Consult poll shows that 88 percent of seniors support including medically necessary oral health coverage in Medicare, and there is strong support from voters on both sides of the aisle.

Keeping up momentum is critical to fully address oral health issues

This effort for medically necessary care is just the first step to addressing the oral health of those who rely on Medicare. This coverage would be vital to helping people in medical crisis, but it does nothing to prevent or treat oral disease in most cases. While this effort is an important way to raise oral health issues with policymakers and meet some critical needs, it doesn’t go far enough in the long run. Health care and oral health advocates must continue to speak up to make sure that oral health coverage is fully addressed. America’s seniors and people with disabilities deserve comprehensive oral health coverage in Medicare.