Nationally, oral health is improving for the population as a whole. However, profound racial and socioeconomic disparities in oral health persist. According to the Centers for Disease Control, people of color experience untreated tooth decay nearly twice as much as non-Hispanic white adults. Adults with low socioeconomic status are less likely to have dental insurance and are more likely to suffer from untreated tooth decay and gum disease. Lack of preventive services and early treatment often results in chronic dental conditions, which are extremely painful and can even be fatal.
Maryland Dental Action Coalition
The Maryland Dental Action Coalition (MDAC) is the state’s leading nongovernmental oral health policy and advocacy organization. In 2015, a grant from the Abell Foundation enabled MDAC to commission the Hilltop Institute at UMBC to assess different options for providing Medicaid dental coverage for adults. MDAC conducted a follow-up analysis of the costs associated with emergency room visits by adults with chronic dental conditions in Maryland. In fiscal year 2016, there were more than 42,000 visits to the emergency department for dental issues, which cost a total of $23 million. Medicaid paid over $9.9 million for 53% of those visits despite covering just 15% of the adult population in Maryland. Additionally, emergency departments usually cannot treat the chronic dental issue and provide only temporary, palliative care.
MDAC has used these two studies to advocate for expanded adult dental coverage. In 2019, the Maryland Department of Health launched the Adult Dental Waiver Program, which provides dental benefits of up to $800 annually to adults ages 21-64 who are dually eligible for Medicaid and Medicare—typically people with significant disabilities and chronic health issues. There are about 7,800 dually eligible people in Baltimore City and 35,000 statewide.
With support from the Abell Foundation and other funders, MDAC created a collaborative of dental health and social service providers charged with ensuring the success of the waiver program. The collaborative has helped dental providers complete credentialing requirements and successfully bill Maryland Medicaid for services. It has conducted outreach to eligible participants through a direct postcard campaign and through organizations that work with dually eligible clients.
These efforts have been successful. In just eight months (June 2019-February 2020), at least 550 unique dental providers submitted claims for services for more than 4,000 clients, and Maryland Medicaid has reimbursed providers for more than $1.4 million worth of services. MDAC continues to support implementation of the Adult Dental Waiver Program, and continues to use research to advocate for incremental expansions of Medicaid coverage of adult dental care.
Information published March 2021.