CHICAGO, Aug. 16, 2024 — Significant barriers to dental care still exist for thousands of Medicaid beneficiaries, according to a new report from the American Dental Association’s (ADA) Health Policy Institute (HPI) and the Association of Dental Support Organizations (ADSO). The two organizations recommend reforms to federal and state public policy that would make it easier for dentists to enroll in Medicaid and for patients to access critical oral health services.
The new report indicates that patients face both financial and systemic hurdles to obtaining dental care through Medicaid. According to a survey of Medicaid beneficiaries in eight states, nearly three out of five patients were unable to connect with a dentist due to an absence of nearby Medicaid-enrolled providers or providers who could speak their language or were of their cultural background. Additionally, two out of five enrollees said that 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 Dr. Marko Vujicic, 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 study also included insights into why many dentists are unable to provide Medicaid-covered care. Surveyed dentists cited low reimbursement rates, lack of coverage for comprehensive procedures and limitations from state programs as reasons why they could not participate in Medicaid. Administrative constraints, such as prior authorization requests and complex credentialing requirements, were also referenced as considerable barriers to taking part in state Medicaid programs.
Dental practice structure can make a difference in some of these obstacles. The new report indicates that dentists affiliated with a dental support organization (DSO) have higher rates of Medicaid participation than their non-DSO counterparts, potentially due to 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, chief executive officer 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.”
The organizations called on federal and state lawmakers to prioritize reforms that would improve Medicaid enrollees’ access to dental care. These include 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 (SMILED) Act, which would reduce administrative burdens that often discourage dentists from signing up for or staying in the Medicaid program.
To learn more about the ADA’s and ADSO’s advocacy efforts, visit ada.org/advocacy and theadso.org/advocacy-2.