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Bill seeks broader dental coverage for Medicaid

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A bill introduced by Sen. Thomas M. “Mac” Middleton (D-Charles) would reduce emergency room visits for chronic dental conditions, potentially saving Southern Maryland hospitals hundreds of thousands of dollars a year, although financial analysts say the program would also increase state Medicaid expenditures.

Middleton introduced Senate Bill 284, cosponsored by Sen. Guy Guzzone (D-Howard) in January. So far, it has been heard by the Finance Committee, which Middleton chairs, but no further action has been taken on it.

The bill was in part motivated by a study published by the Maryland Dental Action Coalition that found Medicaid payments to cover emergency department and inpatient visits by adults with dental conditions total around $12 million a year.

The study also found that even though adults who receive Medicaid make up roughly 15 percent of the state’s population, Medicaid is responsible for paying more than half of the emergency room costs for adult dental care.

“Maryland has become a model for the nation in improving the oral health of children,” Mary Backley, executive director of the Maryland Dental Action Coalition, said in a press release. “Now we need to do the same for adults.”

A fiscal analysis of the bill’s impact says the state’s Medicaid expenditures would increase by just over $15 million beginning in the 2020 fiscal year, when the program would take effect, and jump to $31.6 million the following year.

However, Middleton noted that the fiscal analysis does not take into consideration the benefits that would in many cases offset the increase, an argument that he believes is supported by extensive research.

In making the case for the bill, Middleton points out that studies have found that Medicaid spending tends to drop between 31 and 67 percent when adults receive preventive dental care. Managed-care organizations voluntarily spend about $14 million annually on basic dental services.

“We’ve got the numbers, but we may be a bit premature,” Middleton said, noting that legislators might prefer to undertake a pilot study to allow researchers to understand the impacts on patients and health care organizations in Maryland.

Maryland is one of only 16 states that do not offer adult dental coverage as part of its Medicaid program. Because of that, Middleton argues, the state can’t claim federal matching funds to help cover dental care treatments.

“We are leaving millions of federal dollars on the table,” Middleton told his Senate colleagues.

If passed, adult dental care coverage would not be offered right away through the state’s Medicaid program. The bill stipulates that the Maryland Department of Health would have a year to determine how best to structure the program to ensure that it balances care options with anticipated expenditures.

Some of the options to be explored include providing incentives to managed care organizations to offer more comprehensive dental programs and encouraging safety net providers and private practices to begin offering Medicaid dental care to adults.

The cost savings for hospitals in Southern Maryland could be significant. According to the MDAC study, in 2016 Charles County hospitals logged over 900 emergency room visits by adults for chronic dental conditions, providing care that totaled just over $414,000. In Calvert County that same year, hospitals reported 669 visits requiring over $305,000 in care, while in St. Mary’s the totals were 868 patients and nearly $464,000 in care.

The MDAC study focused on hospital emergency room and inpatient visits by adults seeking care for chronic dental conditions. It did not include people who sought care through other means such as ambulatory surgery.

“If anything, we are underreporting the extent of the problem,” said Dr. Natalia Chalmers, the director of analytics at the DentaQuest Institute, which performed the study for MDAC.

Middleton said that he is hopeful that Maryland health Secretary Robert Neall will support at least a pilot study to demonstrate the feasibility of providing adult dental care through Medicaid.

“I’m very optimistic it will go forward,” Middleton said in an interview. “If Secretary Neall says lets go ahead and at least do a pilot study, then it will move out of the committee and to the Senate for a vote.”

“I think the chances of getting something done this year are good,” Middleton added.

Chalmers said that she is pleased that legislators are basing their recommendations on scientific evidence as presented in the MDAC study, but noted that not implementing the program also incurs costs.

“Every day we don’t have the benefit, the more adults will seek care in the hospitals,” Chalmers said. “Ultimately the taxpayers cover a lot of that cost.”

Chalmers noted that for many of the people who visit emergency rooms 20 or more times a year for medical treatment because they do not have health insurance, a large percentage of them have chronic dental conditions in addition to drug addiction and behavioral health issues.

“Dental care cannot be looked at in isolation,” Chalmers said. “It’s part of a bigger picture.”

Although it was beyond the scope of the MDAC study, Chalmers and her colleagues also looked informally at the relationship between dental pain and death. They found that over the four years of data that they looked at for their study, 15 people died in the emergency room or after being admitted to the hospital, due to the seriousness of their dental-related conditions.

“Why would we cover every other benefit and not dental health?” Chalmers asks. “It’s like telling people that we’re going to provide health care coverage for every part of your body except your right arm.”

Correction: the title was updated to reflect that the bill seeks broader Medicaid coverage, not Medicare.

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