Carlton Clemons suffered excruciating discomfort from decaying wisdom teeth for months. He hardly ate and relied on pills to get by because he couldn’t sleep.
The $1,300 per month his family receives in Social Security and disability income was insufficient for the 67-year-old dentist from Nashville, Tennessee, to visit the dentist. He therefore anticipated the state’s launch of a program this year that will provide dental care to more than 650,000 Medicaid participants like him who are 21 years of age and older. The program costs Tennessee around $75 million a year.
He stated, “Man, I thought I had made it to heaven since the pain was over,” after the tooth was extracted in July at the Meharry Medical College School of Dentistry. I was ecstatic when they finally removed it. Gladly, I was. Right after that, everything changed.
The clinic has extracted the teeth of his wife Cindy, who is also a Medicaid recipient.
Dental care for children must be provided by states under Medicaid, a federal and state health insurance program for the poor, but not for adults. But this year, six states started or extended their Medicaid programs to offer coverage for adults as a result of a greater understanding of the financial and health consequences associated with poor oral health and an infusion of federal pandemic funds.
In many of those states, access is still problematic because some dentists won’t accept Medicaid patients. Even those who desire to grow their profession encounter red tape while trying to do so.
The implementation of Medicaid dental insurance, which began in January, delighted Dr. Victor Wu, chief medical officer for Tennessee’s Medicaid program, but he acknowledged the state needed to expand its network and boost dentist involvement.
Even though dental care is frequently considered regular, the impoverished frequently go for years or even decades without receiving any. The expenses of doing so are substantial for both taxpayers and those who cannot afford therapy.
According to a Texas A&M University research, the $2 billion annual expense of treating avoidable dental diseases accounts for up to 2.5% of emergency department visits. According to the Federal Centers for Illness Control and Prevention, untreated dental illness costs the US economy an additional $45 billion in productivity each year.
“You put off care and you get sicker and then it becomes a crisis where you’re missing work or you end up going to the emergency department and you get a big bill and you don’t get the tooth actually taken care of,” said Dr. Rhonda Switzer-Nadasdi, the chief executive officer of Interfaith Dental Clinic, which has offices in Nashville and Murfreesboro, Tennessee.
According to Switzer-Nadasdi, “You need good teeth to have good employment.”
According to the CareQuest Institute for Oral Health, a nonprofit that promotes expanded dental care, all states offer some Medicaid dental benefits for adults, but some only cover emergency care or are restricted to certain groups of people, such as pregnant women or people with intellectual disabilities.
The newest states to start or increase dental coverage were Hawaii, Tennessee, Kentucky, Michigan, Maryland, and New Hampshire; they did so this year.
To provide dental treatment to its 88,000 Medicaid enrollees in New Hampshire, the state will spend $33.4 million over the course of a year.
The primary author of the bill to expand dental services, Democratic Rep. Joe Schapiro of New Hampshire, said there is “increasing understanding that oral health is indivisible from health care.” “The amount of money spent on other health care issues that are connected to oral health, and the amount of money spend on emergency care when people can’t get any kind of preventative or restorative care, are not only unfortunate for those people’s health but cost a tremendous amount of money,” the author said.
After his proposal was rejected by the Republican-led legislature in Kentucky, Democratic Governor Andy Beshear moved through with emergency measures to ensure that nearly 900,000 residents would still have access to dental care.
“This program does just that,” he added. “We are focused on removing barriers that prevent people from returning to the workforce.”
Virginia’s Medicaid program was expanded in 2021, and for the fiscal years 2022 and 2023, $282 million was budgeted to pay for dental care for more than a million beneficiaries. Last year, Kansas provided roughly 137,000 Medicaid beneficiaries with access to dental care for a cost of $3.5 million in 2022 & $1.2 million in 2023.
While supporters applaud these modifications, Texas, Alabama, Mississippi, Utah, and Louisiana continue to only provide a small number of advantages.
States were forbidden from conducting eligibility reviews during the pandemic, but millions of participants are being removed from the Medicaid program nationally even as states expand dental coverage.
In addition, there are several problems in states that have increased care, including Tennessee. One of the largest is that there aren’t many dentists accepting Medicaid patients, particularly in rural regions. This leads to lengthy wait periods and lengthy travels to find care. In New Hampshire, only approximately 15% of dentists accept Medicaid; in Tennessee, 24%; and in Virginia, 27%.
Medicaid reimbursement rates are to fault, according to a lot of dentists and organizations supporting expanded treatment. According to statistics from 2022 that the American Dental Association analyzed, New Jersey only covers 13.3% of what a dentist typically charges, Michigan covers 17%, and Rhode Island covers 22.4%. Little more than 28% of each is covered by Illinois, New York, Ohio, and Oregon.
The majority of states, however, only cover between 30% and 50%, with Delaware covering 76.9% and Alaska and North Dakota covering at least 55%.
Some of Indiana’s Medicaid reimbursement rates for dental care, according to Dr. Heather Taylor, an assistant professor at Indiana University’s Richard M. Fairbanks School of Public Health, have not increased since 1998.
Since we don’t pay our dentists even half of what they could receive from commercial insurers, it almost seems as though we’re encouraging them not to help those who are in need, she added.
Medicaid consumers have a disproportionately high demand for services from Tennessee Family Dental, which operates four clinics around the state. The business’s dental owner, Dr. Ryan O’Neill, claimed that he received 300 calls on the first day and that some of his clients had traveled up to 30 minutes to see him.
He wants to hire more dentists but noted that the process of getting one registered under Medicaid can take up to four months. He also has problems with the Medicaid billing system, which he said is inconsistent in what is authorized and what is denied and consistently denies some claims.
Offices are reluctant to join networks because there are numerous unknowns, according to O’Neill. We’re still learning the rules and how to apply them in certain situations through trial and error, as you would say.
A 26-year-old mother of five from Ashland, Tennessee, named Danielle Wilkes made the 90-minute drive to see O’Neill after contacting dozens of dentists in the area and discovering that none accept Medicaid. June Renee Pentecost, her cousin, accompanied her to the clinic.
Wilkes had been putting off seeing a dentist for the last five years after having numerous teeth knocked out in a vehicle accident. She was informed that getting many crowns would cost her thousands of dollars, which she could not afford.
“At first, I was upset, but I realized there was nothing she could do. She added that the agony frequently made her cry and that she would simply have to wait till her children were adults.
However, there she was sitting in a dental chair with pink hair that contrasted with O’Neill’s black scrubs and those of dental assistant Jasmine Webb. The soft-spoken Wilkes admitted that she was “just happy” to have the work completed in the end, even if it cost her $400 that Medicaid would not cover.
Pentecost was having a root canal inspected in a different room. She had been in discomfort for years, but it had been more than ten years since she had last visited a dentist due of the expense. She had five children and assumed that paying for dental care would reduce her ability to provide for them.
She said, “I couldn’t play with my kids because my head hurt.”
The 30-year-old was happy to finish the task but questioned why the state had not made the incentive available earlier.
Once I get my teeth corrected, I’m hoping my pain will go away so I won’t have as many headaches and feel as lousy, she added.