Mediating Medicaid: Why States are Cutting Dental Benefits

Updated: 2/11/2020

The Situation

We’re all aware of America’s healthcare debates and the ongoing Medicaid concerns, but the two issues come to a head under the dental health crisis. Across America, low-income families without health insurance are suffering from oral diseases and a lack of treatment options. Why? This is due to procedure costs climbing ever higher and many dental professionals denying Medicaid as a form of payment. With healthcare costs on the rise, many states are seeking new ways to maintain budgets. No state is immune but some, including Alaska, Florida, Vermont and Illinois, are facing legislation changes that seal the deal for future healthcare strains.

Illinois boasts some of the highest dental costs in the country. Treatment costs in the state average approximately 9 percent higher than the national average costs for root canals, fillings, crowns, braces and extractions. The National Dental Advisory Service places the state in the top 17 percent for dental treatment costs in the country.

Dental benefits in Illinois under this plan include the cost of exams, basic and advanced restorative services, dentures and oral surgery services with no annual limit. The state proposed a new law eliminating these dental care benefits for adults on Medicaid in order to shift dental patients, and the costs of care, to emergency room treatment- encouraging patients to wait until their oral ailments become infected or unbearably painful. The only services that dental professionals will continue to provide are emergency tooth extractions.

The Proposed Solution

State governments are finding such ways around these expenditures in order to cut costs and ease budget allocations. Medicaid is a program that provides healthcare to low-income families, supported jointly by the state and federal governments. While these state programs are required by federal laws to cover comprehensive dental services for children, coverage for adult dental services is optional.

Despite the need, lawmakers have looked to cut dental benefits to keep this growing expense down. When making Medicaid reductions, adult dental coverage is one of the first areas states pay attention. For adults, states often choose to limit services offered for coverage or offer no coverage at all. Illinois is just one state entertaining the idea of a program to cut this coverage for adults altogether. Last week, Gov. Pat Quinn signed a $2.7 billion package of cuts and taxes aimed at reducing the debt of Illinois’ Medicaid program.

Why?

The state’s area of concern lies in the failure of Medicaid’s treatment payments to cover the full cost of the service. With insurance, the treatment amount is paid directly from insurance company to the provider. However, the program’s payments are significantly lower after going through the state, which requires a dental professional to wait for reimbursement over a period that can last six months. As a result, there is a shrinking number of dental providers willing to accept these patients.

Most of Illinois’ Medicaid clients are pregnant women, children, the elderly and the disabled. Illinois falls in the top 30 percent of the percentage of population enrolled in the plan. An article by the New York Times earlier this year stated the national number of enrollees has nearly doubled, to 2.7 million in 2011 from 1.4 million in 2000, and the program’s costs could reach $12 billion in Illinois in the next five years.

With many states facing similar Medicaid situations, the need for a national healthcare solution is apparent. Until the healthcare reform is settled and a standard for this program’s acceptance is put into place, the dental health crisis will only grow larger. For now, individuals are left to determine the best options for their insurance and dental discount needs without relying on Medicaid.