We are in crisis: Virginia is facing a significant budget shortfall and health coverage is top of the list for evaluating ways to cut back. Our legislators are meeting today to consider a spending cap on Medicaid dental benefits. But protecting, or even expanding, cost-effective health care programs will be essential as Virginia and state governments across the country grapple with historic budget changes because these programs actually keep costs down in the long run. Adult dental benefits are a perfect example.
With more than 30 years as a practicing general dentist in Houston, and now in my role as dental director for DentaQuest in Virginia, I see firsthand how expanded access to dental treatment can improve health outcomes and reduce overall medical costs. And my experience aligns with the evidence. Capping dental benefits simply leaves Virginians to delay care and turn to the emergency room for help.
Research demonstrates the association between comprehensive Medicaid dental benefits and better oral and overall health, specifically that a healthy mouth is connected to decreased risk of heart disease and other physical health concerns. Without coverage, people are more likely to postpone care and wind up in the emergency department (ED), where care is more expensive and usually treats pain rather than an oral health condition.
We’ve already seen several states trim spending by cutting Medicaid adult dental benefits and then subsequently reinstate adult dental coverage after unwanted effects. Missouri restored Medicaid dental benefits in 2016 to about 350,000 adults and, by 2018, the state observed a 38% decrease in the rate of ED visits for nontraumatic dental conditions. California and Massachusetts had similar experiences.
According to Health Policy Institute research from the American Dental Association (ADA), removing adult dental benefits from Medicaid today could raise ED costs for dental conditions by close to $300 million. For Virginia, the same researchers estimate an overall added annual health care cost of $39 million when accounting for diabetes, heart disease and pregnancy costs related to untreated gum disease. That’s close to $200 million over five years.
They conclude, “The elimination of adult dental Medicaid benefits would significantly limit access to cost-effective preventive and early intervention dental care, ultimately contributing to poor oral and overall health. Such decisions will result in both immediate and long-term financial burdens on states’ budget and economy.”
There are economic benefits too. An ADA report underscores how poor oral health can make it harder for people to find work. In states without Medicaid dental coverage, 60% of enrollees say the appearance of their mouth and teeth affects job interviews. Only 35% of enrollees in states with dental coverage feel similarly. Considering some of the new requirements for Medicaid eligibility, this becomes an even greater need.
Though it may look good on paper, spending caps actually shift costs downstream. Let’s not kick the can at the expense of our most in-need Virginians. We’ve seen incredible strides increasing access to dental care since expanding the benefit. Policies should further this progress, not reverse it.
Given the importance of dental care to overall health, we must continue investing in — and maintaining — Medicaid adult dental coverage. Let’s not be shortsighted; comprehensive dental coverage improves health outcomes, reduces overall medical costs and drives economic growth.
Terry Dickinson, DDS, of Richmond is a former executive director of the Virginia Dental Association and founder of Virginia’s Mission of Mercy dental program, a nationally recognized initiative improving access to care for underserved populations. He currently serves as dental director for DentaQuest, part of Sun Life U.S., in Virginia. He also is founder and CEO of Emerging Leadership, LLC, where he focuses on health care leadership development.
