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Medicaid success in Missouri

November 30, 2018

By Michelle Manchir

Dental ED visits graph

Adult Medicaid benefits in Missouri are substantially reducing the number of claims submitted for nontraumatic dental emergency department visits, according to data from the state.

Missouri’s state legislature in 2016 extended adult Medicaid dental benefits, including exams, X-rays, cleanings, scaling and root planing, fillings and extractions.

In January 2015, before the benefit was in place, the state recorded 1,439 nontraumatic emergency dental department visits (based on the number of claims) while in January of 2018, 827 emergency department claims for dental visits were made.

Data from February through April 2018 show similar numbers, with claims decreasing by nearly half for each.

“Adult dental services may have had a direct impact on breaking the cycle of seeking treatment from a Medicaid provider in an emergency department because that is the only place to find care for dental pain and infection,” said Dr. John Dane, state dental director for Missouri. He called the change a positive one.

“Paying for nontraumatic dental treatment in the emergency department accomplishes very little,” he said.

The Missouri Dental Association attributes the adult Medicaid benefit to helping more Missourians avoid the emergency department when seeking dental care.

The MDA, along with the Missouri Coalition for Oral Health and the Missouri Primary Care Association, “steadily beat the drum to get the benefit established and to increase reimbursement rates,” said MDA Executive Director Vicki Wilbers.

“It wasn’t something spectacular that happened in one legislative cycle. Improvements to Medicaid are always part of our legislative agenda,” said Ms. Wilbers, adding that MDA hopes Medicaid-eligible patients getting their dental care in the dental offices encourages them to establish a dental home with a Medicaid provider so patients can maintain access to preventive care. 

The more the adult Medicaid benefit is used, she said, “the more we can show its value and long-term cost savings to lawmakers to encourage them to continue to fund it and to continue to fund provider reimbursement rates. It’s a cycle and when it’s all moving in a positive direction (the benefit being used and providers receiving a rate that allows them to treat this population), it is good for the profession and for the patients.”

Increasing emergency department referrals for non-traumatic dental visits is a major tenet of the ADA’s Action for Dental Health campaign. There are more than two million visits to hospital emergency rooms each year for dental pain, according to the ADA Council on Advocacy for Access and Prevention. Emergency department visits for dental treatment cost three times as much as a visit to the dentist, according to the council. For more information on Action for Dental Health, visit

Dr. Dane and Ms. Wilbers both said other states could model the Missouri adult benefit program.

One essential action is to educate legislators on the positive effects of an adult dental program, emphasizing the savings that can be generated for the Medicaid program, said Dr. Dane.

“My advice would be to dive into the data to determine what is going on in your state in order to ‘personalize’ the information so that when you are discussing this with legislators, they know what is going on in their state,” Dr. Dane said.

Key to getting the word out is collaboration, such as working with oral health and public health stakeholder organizations, and with patients, said Ms. Wilbers, adding that informing stakeholders is crucial. The MDA dedicates a page on its website to Medicaid information, including dental billing tips, provider workshops and bulletins, and a link to the ADA Medicaid’s Provider Reference Guide.

Persistence is also important.

“Sometimes you have to lay a foundation for future goals,” she said. “We can’t ever let our guard down.”