NDA Statement on Medicaid Coverage of Adult Dental Services

Medicaid is a joint federal-state program. States establish their own eligibility standards, benefit packages, provider payment policies, and administrative structures under broad federal guidelines. State Medicaid programs are required to cover dental services for children and youth under age 21 but federal law does not require dental benefits for adult Medicaid beneficiaries. States that provide Medicaid dental benefits to adults may restrict coverage to pain relief, emergency care for life-threatening conditions, and extractions. States may also limit the number of certain services they will cover annually. Four states do not offer any adult dental benefit to Medicaid beneficiaries. As an optional Medicaid benefit, adult dental coverage is vulnerable to cutbacks and elimination when states face budget challenges. 

  • Whereas adults with low-incomes suffer from poor oral health disproportionately because the cost of oral care is a major obstacle to accessing preventive and restorative oral health services; 
  • Whereas poor oral health can contribute to elevated risks for poor pregnancy outcomes and systemic diseases such as diabetes, respiratory problems, and cardiovascular disease; 
  • Whereas declines in vital bodily functions such as eating, breathing, and speaking as well as self-esteem and social interaction due to poor oral health can adversely impact quality of life and behavioral health; 
  • Whereas research has shown that when states reduce or eliminate adult dental benefits, unmet oral care needs increase, preventive oral health care utilization decreases, and emergency department use for oral health problems increases; 
  • Whereas poor oral health can lead to lost workdays and its visibility can reduce employability; 

Resolved, that the NDA supports a federal requirement for adult dental services in state Medicaid programs that would provide a comprehensive mix of diagnostic, preventive, and restorative oral health services to restore and maintain beneficiaries’ oral health status; 

Resolved, that the NDA supports a reasonable reimbursement rate to attract a robust network of Medicaid-contracted dental providers; 

Resolved, that the NDA supports the avoidance of undue administrative requirements on dental providers; 

Resolved, that the NDA supports Medicaid reimbursement for dental patient navigation, care coordination, and telehealth to improve access to care and utilization of dental coverage. 

Resolved, that the NDA supports a Federal requirement for State Medicaid programs to collect data and report on core measures relevant to racial and oral health equity annually to be used to address disparities. 

The NDA is concerned that of the ten states with the highest percentages of Blacks/African Americans (B/AA) in their states in 2018 (latest data available), only two of the states offered 2 comprehensive Medicaid adult dental benefits. The lack of comprehensive Medicaid adult dental benefits is a structural barrier to oral care for low-income B/AA residents in the remaining eight states. 

The results of racism in our nation’s unequal health care system abound often to the point of many adult Medicaid beneficiaries suffering from preventable oral disease simply because of their age, their income levels or the states in which they reside. A Medicaid adult dental benefit is a matter of social justice. The uneven State Medicaid adult dental coverage and access challenges often lead to higher rates of oral disease, costly oral health-related hospital visits, and missed workdays for low-income adults. A mandatory State Medicaid adult dental benefit with a comprehensive mix of reimbursable services would improve racial and health equity as well as oral health status. 

The National Dental Association is comprised of thirty-nine state and local chapters throughout the U.S. Its family member organizations include the National Dental Hygienists Association, National Dental Assistants Association, Auxiliary to the National Dental Association, and National Dental Association Foundation. The NDA is the oldest and most prestigious association of people of color in the dental profession. The NDA promotes access to oral health care by serving underserved and vulnerable populations. As both oral health providers and residents of the communities that we serve, the members of the NDA and its family organizations seek to improve the health of the underserved, eliminate disparities, and promote health equity. 

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