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Maryland bill authorizes Medicaid adult dental coverage pilot program

May 16, 2018

By David Burger

Photo of Dr. Romaine and Eric Biagioli
Thumbs up: Dr. Diane Romaine, past president of the Maryland State Dental Association and current president of the Maryland State Dental Association Foundation, right, and Eric Biagioli, Maryland State Dental Association Foundation executive director, smile while holding the pen Gov. Larry Hogan used to sign a Medicaid pilot program into law May 15.
Annapolis, Md. — Maryland Gov. Larry Hogan signed a bill on May 15 that advocates hope will lead to the eventual establishment of a Medicaid adult dental benefit in the state.

The Maryland General Assembly unanimously passed the bill, SB 284, in April.

The legislation requires the Maryland Department of Health to implement a pilot program for adult dental coverage, which could begin as early as January 2019. The test program will focus on those qualifying for both Medicare and Medicaid benefits.

The Maryland State Dental Association and the Maryland State Dental Foundation played a role in the bill's passage.

Dr. Diane Romaine, past president of the Maryland State Dental Association and current president of the Maryland State Dental Association Foundation, said that a Maryland study after the 2014 fiscal year showed that the cost savings of adding a Medicaid adult dental benefit were significant. The study, published in a research brief by the ADA Health Policy Institute in late 2014, showed that a "Medicaid program could save up to $4 million per year by diverting emergency department dental visits to dental offices where more appropriate and more cost-effective care can be provided."

According to Medicaid.gov, states are required to provide dental benefits to children covered by Medicaid and the Children's Health Insurance Program, but states choose whether to provide dental benefits for adults.

Currently, Maryland Medicaid does not cover dental services for adults 21 years or older, except for pregnant women, individuals enrolled in the Rare and Expensive Case Management and Emergency Services program and dental problems provided in a hospital emergency department, according to a February 2016 report conducted by the Hilltop Institute, a nonpartisan health research organization.

According to a study, conducted by DentaQuest Institute in fiscal year 2016, Maryland adults made 42,327 emergency department visits for chronic dental conditions in the fiscal year 2016.  These visits had an average charge of $537 per visit or a total charge of $22.7 million.  These visits represent almost two percent of overall emergency room costs. Medicaid paid for 53 percent of those visits, even though Medicaid participants only account for 15 percent of the adult population in Maryland.

The study performed by the DentaQuest Institute also shows some patients have such severe dental needs that they need to be admitted to the hospital.  These admissions cost an average of $9,274, for a total of $4.6 million a year. In testimony to the Maryland General Assembly, Dr. Natalia Chalmers, Director of Analytics and Publications at the DentaQuest Institute, said that between 2013-2016, 15 adults died in the hospital after being admitted with severe dental conditions.

In Maryland, "Medicaid dental benefits for adults in emergency rooms are limited to palliative care through pain medication and antibiotics, not definitive restorative and preventive care," Dr. Romaine said.

The Maryland Dental Action Coalition, a leading nongovernmental oral health policy and advocacy nonprofit in the state, hailed the bill's passage.

"The single most important step to improve the oral health — and overall health — of Marylanders is a Medicaid program that covers dental services for adults," said Mary Backley, Maryland Dental Action Coalition executive director, in a MDAC news release. "Maryland has become a model for the nation in improving the oral health of children. The passage of SB 284 is an important step forward as we work to do the same for adults."
 
Salliann Alborn, chair of the MDAC policy committee, said in the news release, "Many Maryland adults face serious financial obstacles to obtaining dental care. This pilot program is an important step forward in demonstrating that a Medicaid adult dental benefit that enables adults to establish a dental home, obtain preventive care and avert costly dental conditions is a good investment in health outcomes and the fiscal health of Medicaid."

As of November 2017, 33 states, including the District of Columbia, expanded Medicaid eligibility, according to the ADA Health Policy Institute. Of those states, 24 states, including the District of Columbia, provide at least limited dental benefits for adults.