Access to Oral and Dental Care
5.5 minute read
Our Position
A dental benefit for adults with disabilities in Medicaid will not only improve their oral and overall health outcomes, but also make better use of public funds.
CTD is the lead advocate supporting legislation relating to Medicaid reimbursement for dental services provided to adults with disabilities. Language about a preventative benefit passed in 2021 in SB 1648 (Perry) and HB 2658 (Frank). However, the Texas Health & Human Services Commission (HHSC) has not yet implemented the program. Though independent analysis showed the state would save more money through reduced ER visits, hospitalizations, and acute care, HHSC contends an initial budget number must be appropriated. We worked to secure the funding in 2023, but the Legislature rejected a rider to fund access to dental care for those who have zero benefits.
The Latest
October 31, 2023: Read about our recent work in a blog post from the CareQuest Institute for Oral Health: A Team Effort: The Push for Better Oral Health Care for Individuals with Disabilities
Partners
- Texas Health Institute
Background
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.
A dental benefit would not only improve the oral and overall health outcomes of this population, but also make better use of public funds.
National and Texas experts agree that 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.”
In Oral Health in Texas: Emergency Department and Inpatient Hospitalization for Non-Traumatic Dental Conditions in Texas, the Texas Health Institute concludes that, relative to a preventative dental care visit in a dentist's office or community setting, an ER visit costs 9 times as much, and hospital in-patient care costs 230 times as much.
In addition to reducing reliance on emergency rooms for dental pain, 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. For example, the Health Policy Institute (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.
Third, access to preventive dental care will reduce consumers' need for and access to pain killer and 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. Just a few years ago, a national study reported that 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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CTD and our partners have made substantial progress on this issue. 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 laid with our partners during the interim, led to the filing of SB 556 (Kolkhorst) and HB 1647 (Deshotel) in 2019. This bill would have enacted a dental benefit for adults with disabilities in Medicaid. However, a challenging fiscal note, called misleading by legislators, slowed the bills. Fortunately, HB 4533 (Klick) passed with an amendment that called for a dental services pilot, the first time a dental benefit for non-Waiver adults is mentioned in Texas statute. Of note, individuals participating in the pilot will be eligible for services based on functional need, rather than age of onset of their disability. CTD played a critical role in including this game changing language in HB 4533. The pilot was funded by legislation in 2021.
There were two developments worth noting from the 2020 interim:
- HHSC researched the HB 4533 dental pilot, which is set to roll out in 2023. A July HHSC update reported that adults in Medicaid waivers who have a dental benefit have fewer ER visits. HHSC staff reported that the savings from avoided ER visits actually paid for the dental benefit. About 10% of Medicaid adults are in waiver level services and have access to a dental benefit, the other 90% have little or nothing.
- Two Texas Medicaid managed care organizations, Superior HealthPlan and United Healthcare, continued work in progress on pilots and data gathering, to start ahead of the State's pilot.
In 2021, a preventative dental bill reached the finish line. From February to May of that session, language about a preventative benefit passed through quite a few different bills, finally landing in two Medicaid omnibus bills, SB 1648 (Perry) and HB 2658 (Frank). The bills included a provision for a preventative visit to the dentist each year for adults in STAR+PLUS non-HCBS. However, HHSC has not yet implemented the program due to budget constraints. This will be the focus of CTD's dental advocacy in 2023.
Further Reading
- Brief: Texas Health Institute's Implementing a Medicaid Dental Benefit for Adults with Disabilities Can Yield Significant Cost Savings + April Addendum
- Podcast: Episode 46 of Texas Impact's Weekly Witness, where our Dennis Borel and the Texas Health Institute's Dr. Josefine Ortiz Wolfe discuss the state of oral health in Texas in 2019
- Brief: Health Policy Institute of the American Dental Association's Estimating the Cost of Introducing a Medicaid Adult Dental Benefit in Texas STAR Plus Program
- Blog: Barriers to Dental Care Susie Angel
