Giving teeth to Medicaid

The promise of enhanced access and preventive care was the force that through Congress drove the Affordable Care Act. Now the healthcare mosaic falls together, and that includes oral health. The Washington Legislature must act to provide dental coverage to Medicaid-insured adults as a requisite feature of Medicaid expansion.

“Expansion” is something of a misnomer. Last year, the U.S. Supreme Court, in upholding the Affordable Care Act, ruled that states may determine separately whether to participate in expansion. The move, which saves the state $225 million in the 2013-15 biennium, will allow 250,000 more Washington residents to receive health care.

While services extend to the previously uninsured, including those currently eligible but not enrolled in Medicaid, the federal government is picking up the tab until 2020. In practice, state expenses would be higher if Washington opted out, and few states are giving that serious consideration.

Here’s the catch: Medicaid-insured adults lost their dental coverage in 2011, with exceptions made for pregnant women and some seniors. In 2013, lawmakers in Olympia can restore coverage for adults in the state’s Medicaid plan by applying a portion of the expansion’s savings — approximately $15 million a year.

As the Washington Dental Service Foundation notes, dental coverage under Medicaid is a smart, cost-savings strategy. The top reason for the uninsured to race to the emergency room is for a dental complaint. That’s 54,000 dental-related visits to Washington emergency rooms, a drain of $36 million over 18 months. The ER docs can’t treat the underlying condition, the gum disease, for example, that drives a tooth abscess. This is similarly true for community health centers slammed with dental emergencies. Uninsured patients who could have had a filling are getting their teeth yanked.

Providers such as Dr. Marcia Wharton, medical director at Providence Everett Healthcare Clinic, witness it daily. The costs, human and financial, are enormous.

Teeth are windows to the resume. Recruiters for customer service jobs (or most jobs, for that matter) tend to look askance at applicants with teeth resembling the North Cascades. The health consequences are more severe. Untreated gum disease aggravates diabetes, which can then lead to heart problems, renal failure and amputations (!) Gum disease is already linked to heart attacks, stroke and pneumonia.

Extending oral-health coverage to 780,000 Washington residents is a proactive policy. Lawmakers agree, at least in the abstract. Dental coverage should be integrated into the fabric of Medicaid coverage. Oral health and overall health are one.