Oral Health Coverage Boosted in Some State Budgets, Lessons for 2018

This year, several states passed budgets that expand oral health coverage for adults in Medicaid. Expanding this coverage goes a long way to improving overall health, making oral health care more accessible and affordable, and reducing unnecessary emergency room costs to both states and individuals. Now that state advocates and policy makers are planning for 2018 budgets, it is important to learn from the progress that was made, where these policies fell short, and consider how threats to oral health could also arise in state budget processes.

California Restores One of the Country’s Most Comprehensive Dental Benefits

One of this year’s biggest successes came with California’s budget restoring the state’s Medicaid adult dental benefit to be one of the most comprehensive in the country. Thanks to the leadership of the California Pan-Ethnic Health Network (CPEHN), oral health was a bipartisan priority this session. CPEHN and other advocates were able to work with legislators to put the money from California’s tobacco tax (passed in 2016) toward improving coverage for oral health services and increasing provider rates for these services. While there is still room to improve this benefit, this was a huge win for CPEHN and Californians.

Budgets Can Provide an Avenue to Make Important Steps towards a Comprehensive Benefit

Massachusetts also made progress toward improving their adult dental benefits in their state Medicaid budget this year. Massachusetts currently has a limited adult dental benefit. While the state has not yet authorized restoration of its previous comprehensive benefit, Boston-based Health Care For All and other oral health advocates were able to ensure that this year’s budget included an amendment directing the administration to come up with a schedule and cost estimate for reinstating comprehensive adult dental benefits by March 2018. This is a great first step that will help make the case for expanding the benefit in the next budget cycle.

In Tight Financial Years, Ensure Your State Does Not Pursue Oral Health Cuts

Oral health advocates need to ensure that budget processes do not result in oral health benefits being cut. Despite the fact that cutting oral health coverage may not lead to realized savings, many states have seen their adult dental benefits slashed in years past. This year, Connecticut’s budget passed 118 days after the Regular Session includes an annual per person cap of $1000 on non-emergency dental care for adults covered by Medicaid. Caps like this one, or cutting benefits more outright, could mean that Medicaid recipients lose coverage, cannot afford to complete their care, and that providers may not be willing to seek necessary prior authorizations for care exceeding the cap or be willing to take adult Medicaid patients at all.

Going in to 2018, it is important that we learn from these states, as well as states like Maryland, Arizona, and Maine that made progress towards adult dental coveragethrough standalone legislation in their sessions this year.