ADA calls for policy reforms to improve Medicaid access

New report highlights barriers to obtaining dental care through Medicaid

The American Dental Association is calling for public policy reforms to make it easier for patients to access critical oral health services and dentists to enroll in Medicaid.

A new report from the ADA Health Policy Institute and the Association of Dental Support Organizations found thousands of beneficiaries face significant financial and systemic barriers to obtaining dental care through Medicaid.

Nearly 3 out of 5 Medicaid beneficiaries surveyed in eight states by HPI were unable to connect with a dentist because of an absence of nearby Medicaid-enrolled providers or providers who could speak their language or were of their cultural background. Additionally, 2 out of 5 enrollees said prohibitive out-of-pocket costs or a lack of covered services made it difficult to care for their oral health.

“Dental care presents more financial barriers than other health care services,” said Marko Vujicic, Ph.D., ADA chief economist and HPI vice president. “While public programs like Medicaid cover a portion of those costs, there are still disparities in care and access among low-income and elderly Americans. That’s why asking our lawmakers to remove some of these impediments to obtaining dental care is critical.”

The report calls on lawmakers to prioritize two pieces of legislation currently before Congress: the Medicaid Dental Benefit Act, which would mandate dental coverage for all adult Medicaid beneficiaries, and the Strengthening Medicaid Incentives for Licensees Enrolled in Dental Act, which would reduce administrative burdens that often discourage dentists from signing up for or staying in the Medicaid program.

In the HPI survey, dentists cited low reimbursement rates, lack of coverage for comprehensive procedures and administrative constraints, such as prior authorization requests and complex credentialing requirements, as considerable barriers to taking part in state Medicaid programs.

Dental practice structure can make a difference in some of these obstacles, according to the report. Dentists affiliated with a dental support organization may have higher rates of Medicaid participation than their non-DSO counterparts because of their economies of scale and lower administrative burden.

“We know that oral health is integral to overall health, so access to oral health care is even more important than ever, particularly for low-income and underserved populations,” said Andrew Smith, CEO of ADSO. “Dental service organizations are committed to access, and we are proud they have the capabilities and resources to serve patients who need and deserve quality care.”

To learn more about the ADA’s and ADSO’s advocacy efforts, visit ADA.org/advocacy and theadso.org/advocacy.