New data: Medicaid adult dental coverage is wise investment for economic recovery, health

by Melissa Burroughs, Colin Reusch

Extending comprehensive oral health coverage to all adults enrolled in Medicaid could save at least $273 million in overall health care spending, per new data released this week by Community Catalyst, Families USA, and the American Dental Association’s Health Policy Institute. Our original research finds this policy change would only cost about $4.64 per person each month, the majority of which would be covered by the federal government. Further, while the estimated net annual cost of this policy is about $836 million, the level of savings generated is a low estimate and doesn’t capture other wide-ranging benefits that come when people have good oral health.

It’s long been clear that expanding oral health care access is vital to advancing racial justice, improving health equity, and reducing economic inequality. Our new analysis also shows it’s cost-effective. It underscores why securing Medicaid dental coverage for adults is crucial to achieving a strong recovery from the pandemic. Federal and state policymakers should meet this moment to drive health and economic gains by ensuring Medicaid covers comprehensive adult dental benefits in every state.

While Medicaid guarantees oral health coverage for children, it’s optional for states to provide dental benefits to adults who rely on the program for their health care. Less than half of states currently offer adults any such coverage. This exclusion risks the health, quality of life, and economic security of millions of people with low incomes. Due to structural racism and economic inequities, it most harms people who are Black, Latino, and other people of color; people with disabilities; and those in rural and tribal communities.

Our health shouldn’t depend on our wealth, where we live, our race, or our age. And our oral health isn’t just about our mouth. It can jeopardize our physical health, making it harder to manage chronic conditions like diabetes and possibly raising health risks in pregnancy. With a minimal state investment per person, policymakers can lift this harmful barrier and deliver huge benefits for people and our economy. It could help nearly 2 million adults gain access to dental care within three to five years, supporting better oral health and overall health.

The new analysis notes that the overall annual federal cost to extend adult dental benefits in Medicaid would be about $535 million. Yet this number may not account for several other long-term improvements. Beyond the millions in savings our research estimated, policymakers could expect even greater fiscal gains. Medicaid adult dental coverage would:

• Avert other unnecessary health care costs. As Medicaid oral health coverage opened the door to regular care for more adults, fewer people would likely turn to emergency departments to relieve dental pain. This change could save our health system nearly $2 billion annually.
• Reduce states’ overall dental spending. While states often consider cutting adult dental benefits when budgets are tight, it’s more cost efficient to provide coverage. Today, states that offer adults limited or extensive Medicaid dental coverage spend less on dental care per person than states that don’t provide any dental benefits, or only offer emergency coverage.
• Improve employment and economic security for families. Studies have shown that expanding Medicaid dental coverage helps people find and keep a job. In addition to improving employment opportunities, good oral health can also increase wages for women in the workforce. These advantages could prove vital for families recovering from pandemic job loss, which disproportionately hurt women and women of color.

COVID-19’s health and economic consequences fell hardest on the same people who confront the greatest hurdles to getting dental care. Congress can remove one significant obstacle while realizing long-term savings by advancing legislation to make comprehensive adult dental coverage a mandatory Medicaid benefit.

Federal policymakers can also support states in extending Medicaid dental coverage to adults by increasing the federal Medicaid matching rate (FMAP). This investment would shore up state budgets still strained by pandemic needs and ensure that every state has the resources to provide oral health care to everyone who needs it.

At the same time, state policymakers don’t need to wait for federal action to improve adult dental coverage and yield its results. In fact, many states have passed legislation this year that makes adult dental coverage more robust. However, these gains are small compared to what could be achieved with federal action.

No one should have to choose between getting dental care and putting food on the table, especially when oral health shapes so many aspects of our wellbeing. This new research shows policymakers can change the status quo in a cost-effective way. Securing Medicaid dental coverage for adults will advance health equity and economic opportunity, investments we can’t afford to delay.

Finally, as policymakers at both the state and congressional level pursue policies to expand dental coverage to adults who rely on Medicaid, they should also consider supporting policies to ensure that everyone is able to access oral health care in their communities. As Community Catalyst has previously highlighted, such policies include expanding the dental workforce through dental therapists and hygienists practicing at the top of their license as well as care delivery innovations like teledentistry.

This insights column is a joint publication between Community Catalyst and Families USA. Colin Reusch is the Senior Advisor, Oral Health Policy at Community Catalyst. Melissa Burroughs is the Associate Director of Strategic Partnerships at Families USA.