Facing unintended consequences of dental policy
A cost-saving policy enacted by the Pennsylvania Department of Human Services may have unintentionally increased spending and reduced access to dental care for adult Medicaid beneficiaries.
Introduced in 2011, the policy was implemented to save the state an estimated $18.9 million per year, according to a report from Spotlight PA. However, under the policy, Medicaid predominantly covered routine dental examinations, cleanings and fillings. Other dental procedures — such as root canals, crowns and emergency examinations — became out-of-pocket costs for patients, often encouraging them to undergo less preferable but more affordable treatments like tooth extractions. Patients who require potentially lifesaving treatment were able to receive treatment with prior approval from the Pennsylvania Department of Human Services.
In response to the consequences, policymakers and health advocates have called for the policy to be overturned. They have argued that the limitations have increased costs among patients who seek dental care in emergency rooms, led to poor oral health and reduced the chances of employment among some patients with missing teeth.
The ADA has also emphasized that the costs incurred by emergency room dental visits could be avoided by standard care at a dental office. In 2023, lawmakers in the Pennsylvania House of Representatives approved a bill to restore Medicaid coverage for adult patients.
Read more: Spotlight PA
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