ADA holds virtual congressional briefing on public programs

Experts present new research on dental benefits in Medicaid and Medicare Advantage

The ADA held a virtual congressional briefing to showcase new data and policy insights surrounding dental coverage in Medicaid and Medicare Advantage.  

The briefing, Beyond the Smile: The Value of Dental Coverage in Medicaid and Medicare Advantage, highlighted how dental benefits can impact overall health system costs, the patient experience and health outcomes. 

During the webinar, ADA staff shared state-specific insights on how proposed Medicaid reforms could affect access to dental care, potential cost increases to health systems if benefits are scaled back, and the implications for lawmakers’ constituencies. The conversation featured ADA President Brett Kessler, D.D.S., Chief Economist Marko Vujicic, Ph.D., and Director of Medicaid and Medicare Program Policy Ian Hedges.  

Dr. Kessler said the ADA is advocating for Congress to protect Medicaid oral health coverage, so millions of low-income adults do not lose access to care. He said the Association supports “adequate funding and sensible program designs” to assist those relying on Medicaid, including children, adults and individuals with disabilities.  

Additionally, Dr. Kessler stated that as Medicare Advantage enrollment increases, the lack of consistency and transparency in supplemental dental plans is a growing concern. Plan designs and options change every year with little data transparency, he said.  

“We’re committed to working with policymakers to ensure better transparency so patients know what benefits they have and how to actually use them,” Dr. Kessler said. “When adults have access to dental care, oral cancer is caught earlier, ER visits go down, children’s oral health improves, and adults feel confident, find jobs, and find ways to rebuild their lives. In short, dental benefits make families healthier, communities stronger and all of our lives better.”  

ADA staff provided research on the current state of adult Medicaid dental benefits, discussed perceptions of dental benefits by Medicaid beneficiaries and providers, and explained the financial impact of what would happen if the adult Medicaid dental benefit disappears across the country.  

According to a 2023 ADA Health Policy Institute survey, more than 60% of Medicaid beneficiary respondents said they do not visit the dentist because there is not enough access for them. Affordability and anxiety or fear of the dentist were also concerns for respondents.  

Another HPI research brief released in March found that if the adult dental benefit were removed across the country, there would be a $1.9 billion increase in health care costs for one year, and a $9.6 billion increase in health care costs for five years. Removing adult Medicaid dental benefits among those currently utilizing dental care would result in more than 2 million adults facing challenges finding work due to their oral health, according to the research brief.  

The ADA’s briefing came just ahead of a Congressional Budget Office report released May 7 estimating loss of coverage for millions of Americas if five major Medicaid policy changes in were enacted. Two of the policy changes, cutting the federal medical assistance percentage for Affordable Care Act expansion enrollees and imposing per capita caps on state funding, were identified by ADA analyses as likely to jeopardize the adult Medicaid dental benefit in many states. 

The virtual briefing also explored the ever-evolving dental landscape within Medicare Advantage plans. Dr. Vujicic presented findings on the wide variation in dental supplemental benefits across plans, how these benefits meet the actual oral health needs of seniors, and what the data reveals about trends in access and adequacy across the country. 

Ninety-eight percent of Medicare Advantage plans include some type of fully optional dental coverage. However, he highlighted that research indicates two-thirds of these plans require cost-sharing for prevention, which is unlike most dental coverage offered in the private market where no cost-sharing is required for preventive services. Dr. Vujicic further noted that Medicare Advantage dental benefits designed to require prior authorization, to cover only preventive dental services, and to have annual plan benefit maximums below $2,500 are linked to higher unmet dental needs and lower dental care use. 

“It’s timely research because certainly the current administration has been signaling quite strongly directionally to move to an increased reliance on Medicare Advantage,” Dr. Vujicic said. “We see the trends here now that a healthy majority of Medicare beneficiaries are actually in Medicare Advantage plans, and our reading of the tea leaves is that the current administration will want to accelerate this significantly, meaning it’s important to understand what’s going on dental-wise within Medicare Advantage plans.” 

For more information, visit the ADA’s Medicaid and Medicare webpages.