Access to Oral and Dental Care

Dental care icon. A tooth shape inside a grey heart.

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Our Position

FOR SB 556 (Kolkhorst) / HB 1647 (Deshotel): Relating to Medicaid reimbursement for dental services provided to adults with disabilities. A dental benefit for adults with disabilities on Medicaid would not only improve their oral and overall health outcomes, but also make better use of public funds.

At CTD's request, the 2017 Texas Legislature directed the Health and Human Services Commission (HHSC) to complete a study of dental services for adult with disabilities in Medicaid. The recognition by lawmakers that this issue deserved some attention, plus the groundwork we've laid with our partners during the interim, makes us optimistic about passing SB 556 in 2019.

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The Latest

Apr. 22, 2019: The Health Policy Institute of the American Dental Association released Estimating the Cost of Introducing a Medicaid Adult Dental Benefit in Texas STAR Plus Program. The brief puts the cost to the state at around $20 Million and estimates offsets of at least $15.9 Million in reduced emergency department visits, inpatient hospital admissions, and costs associated with diabetes. Several other offsets f(or which no data is available to produce an estimate) include reduced costs associated with other co-occurring conditions and with opioid prescriptions.

Feb. 12, 2019: following office visits with CTD staff and local dental hygiene students in early February, Rep. Deshotel filed HB 1647, a companion to SB 556.

Feb. 4, 2019: Our Dennis Borel and the Texas Health Institute's Dr. Josefine Ortiz Wolfe discuss the state of oral health in Texas on Texas Impact's Weekly Witness livestream.

Partners

Supporting Organizations

Background

updated April 24, 2019, based on more recent research and analysis

More than 400,000 adult Texans in Medicaid receive little to no dental services. When these individuals have dental pain, their only option is the emergency room, where they are treated with antibiotics and pain-killers. Because the real problem remains unaddressed, emergency rooms are being unnecessarily used, state dollars are being unnecessarily spent, a direct pathway for opioid addiction is growing, and employment opportunities for this critical population are impacted.

Access to preventive care will reduce reliance on expensive hospital emergency rooms and admissions for crisis intervention. The American Dental Association states that, "most dental-related emergency department visits can and should be diverted to dental offices through access to routine dental care.”

Average cost of...  
Preventative dental care in dentist office, community setting $200
ER visit $1,853
Hospital in-patient for dental $46,198

Source: Texas Health Institute's report: Oral Health in Texas: Emergency Department and Inpatient Hospitalization for Non-Traumatic Dental Conditions in Texas

The Health Policy Institute (HPI) of the American Dental Association estimates the potential cost savings from:

In addition, a dental benefit will reduce cost of acute care. Better oral health leads to better overall health. Poor oral health can result in increased severity and occurrence of co-occurring conditions, including heart disease, stroke, and high blood pressure. A study comparing the cost of acute care in Medicaid adults found savings of 67% for heart disease, 36% for diabetes, and similar savings in a variety of chronic conditions, when those adults had access to preventive dental care. HPI estimates a cost savings of up to $4,869,606 annually when adults with diabetes enrolled in STAR Plus have increased access to dental care. Texas-specific data is unavailable for comparable estimates for other co-occurring conditions, such as coronary heart disease, asthma, and high blood pressure; however, cost savings should be expected.

Access to preventive dental care will reduce consumers' need for and access to opioid prescriptions, which can lead to addiction. Most Texas Medicaid programs offer emergency-only dental coverage: consumers can only access care when a problem is so bad, they have to go to the emergency room. In this setting, consumers receive a medical intervention of antibiotics and painkillers, often opioids. Nationally, 50.3% of people presenting in ERs for non-traumatic dental pain receive a prescription for opioids.

Finally, poor oral health can detract from many aspects of life, from getting a job to making friends. Of over 100 Texans with disabilities surveyed by CTD and Texas Advocates, 35% reported missing work or school because of mouth pain; 24% and 19% reported that a personal relationship or employment opportunity (respectively) had been affected by the condition of their teeth; and 30% reported noticing that they had been treated differently because of the condition of their teeth.

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