Comment: State cut to Medicaid’s dental care a threat to health

By Jessica Dubek / For The Herald

This year lawmakers in Olympia face some tough decisions to balance the state budget.

Among the many options they will consider, one decision should be easy: Preserving existing Medicaid reimbursement rates for oral health care. Any reduction in dental Medicaid reimbursement rates will have devastating impacts for patient care and will actually cost the state more money.

All across the state, in urban and rural communities alike, patients rely on Medicaid for a variety of services, including preventive care, restorative care to fill cavities and fight dental decay, treating broken or abscessed teeth, endodontics, extractions, dentures and both oral sedation and general anesthesia.

Medicaid covers the most vulnerable patients in our community. They range from children as young as 1-year-old to neurodivergent, nonverbal or developmentally disabled adults. Many have additional physical disabilities or face other health challenges that make their oral health care both more pressing and more complicated. Treating this population safely and effectively takes extra training, specialized skills and additional treatment time, making inadequate reimbursement rates an even larger barrier to care.

Over the last few budgets, the Legislature wisely made some modest and long-overdue increases in dental Medicaid reimbursement. But even with those increases, the rates remain the same as what they were in 2008. Over the last 18 years, wages for dental hygienists and assistants have risen significantly, as have the costs of supplies, insurance and everything else that goes into providing dental care. Medicaid reimbursements are only a fraction — as little as one-half for some procedures — of those provided through commercial dental benefit plans.

As a result, current Medicaid reimbursements already place serious financial pressures on the low-income patients who rely on Medicaid coverage. Worse yet, they can force financially strapped patients to delay the care they need, which has serious long-term consequences.

Delays in care can lead to increased pain, poor sleep and problems focusing at school or on the job. They can increase the risk of more serious decay and infection, result in speech and development issues, and create fear and anxiety regarding future dental care. These delays lead to more serious problems that increase future treatment costs. And because good oral health is essential for good overall health, delays can also lead to broader health consequences, including heart disease, diabetes and adverse pregnancy outcomes.

The proposed cuts to dental Medicaid would be catastrophic for patients in another way: reducing the number of dental offices willing to treat Medicaid patients. Many providers are already struggling to keep up with increased costs, severe labor shortages, and the lingering effects of covid-19 on health care infrastructure. If new cuts force them to limit or drop Medicaid patients altogether, it will reduce access to care, worsening health care disparities, and further overwhelm already taxed hospital emergency rooms, which are the most expensive venue for providing dental care.

Delaying or limiting access to preventive care and forcing patients into emergency rooms will certainly cost the state a lot more money. But the biggest cost of proposed Medicaid cuts will be measured in human terms: more pain, more serious dental problems and more systemic health issues.

As someone who has built my entire career around caring for underserved populations, I believe that everyone in our state deserves access to high quality dental care. Medicaid is designed to help provide that access, regardless of the patient’s financial situation. It is a crucial resource that must be maintained to allow more Washingtonians to enjoy healthy, pain-free oral health.

Dr. Jessica Dubek, DDS, is the founder of DentALL, which provides dental care to underserved communities in Snohomish, Whatcom, Skagit and San Juan counties.