Maryland Poised to Join Small Group of States Offering Comprehensive Adult Dental Coverage Through Medicaid
April 20, 2022
Poor oral health is linked to several chronic diseases, including diabetes, heart disease, and stroke. While states are required to provide dental benefits to children covered by Medicaid, they can choose whether to provide dental benefits to adults. A bill recently signed by Maryland’s Governor fills a gap in access to dental care for adults that has been missing in Maryland and is still missing in many other states across the country. The bill requires Maryland Medicaid to cover adult dental services, including diagnostic, preventive, restorative, and periodontal services.
Maryland’s Governor Larry Hogan has committed to signing and has fully funded SB150, titled Maryland Medical Assistance Program – Dental Coverage for Adults. The bill requires Maryland Medicaid to cover adult dental services, including diagnostic, preventive, restorative, and periodontal services. The bill fills a gap in access to dental care for adults that has been missing in Maryland and is still missing in many other states across the country.
States are required to provide dental benefits to children covered by Medicaid and the Children’s Health Insurance Program (CHIP), but they can choose whether or not to provide dental benefits to adults. Further, there are no minimum requirements for adult dental coverage, meaning that states that do offer this type of coverage have flexibility to determine what dental benefits are provided to adult Medicaid enrollees.
In its most recent issue brief examining dental benefits for adults enrolled in Medicaid, the Medicaid and CHIP Payment Access Commission, a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, noted that while most states provide at least emergency dental services for adults, only around 18 provide comprehensive dental care similar to what is included in the Maryland bill. Adults who are eligible for both Medicaid and Medicare don’t fare any better. Medicare does not cover most dental care, including procedures and supplies like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices.
Dental health is about more than just a pretty smile. Poor oral health is linked to several chronic diseases, including diabetes, heart disease, and stroke; in pregnant women, poor oral health has also been associated with premature births and low birth weight. Oral disease also is associated with risk behaviors such as using tobacco and consuming sugary foods and beverages. People who lack coverage for routine dental services are more likely to forgo regular care and instead seek treatment in hospital emergency departments (EDs) when an oral health problem causes pain or other complications. The majority of dental-related visits to hospital EDs are made for issues that typically can be treated in a dental office. These ED visits are costly and rarely address the root cause because most EDs are not equipped with the clinicians, instruments, or supplies to perform procedures to fully address oral diseases. For example, in all of Maryland, only the University of Maryland Medical Center in Baltimore has on staff clinicians and students from the School of Dentistry and Dental Hygiene.
Congress has made some efforts; most recently, the November 2021 Build Back Better reconciliation package included a Medicare Part B dental benefit, but it was not included in the final bill. Groups such as the American Dental Association are lobbying for a separate and new program instead of tacking dental benefits onto the current Medicare Part B program. While we will likely see other federal legislation, states are continuing to move the needle on adult oral health coverage. Advocates rightfully expressed concern that budget shortfalls related to the COVID-19 pandemic would lead to budget cuts in oral health programs. The good news is that many proposed cuts were eventually unsuccessful and, in fact, since 2020, three states (Virginia, Maine, Oklahoma) have enacted comprehensive legislation and many others have made incremental advancements. Minnesota added periodontal treatment to the state’s adult dental coverage benefit in its 2021 state budget; Louisiana and Texas expanded oral health coverage to adults with disabilities; and 14 states expanded coverage to include women for a certain number of months postpartum.
Providing coverage for adult dental care seems to be picking up momentum at both the state and federal level. While we wait for sweeping legislation, Marylanders can breathe a small sigh of relief that one barrier to dental care access has been lifted.
The post was written by Blair Inniss, J.D, Senior Staff Attorney, Network for Public Health Law- Eastern Region Office.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document do not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.