ADA opposes CMS’ Medicaid block grant guidance

Washington — The American Dental Association said it believes a new policy from the Centers for Medicare and Medicaid could be “detrimental” to the millions of adults who rely on Medicaid for dental care.

The Healthy Adult Opportunity initiative — commonly referred to as Medicaid block grant guidance — is designed to give states what CMS describes as “unprecedented tools to design innovative health coverage programs tailored to the unique needs of adult beneficiaries, while holding states accountable for results and maintaining strong protections for our most at-risk populations.”

But in a Feb. 5 letter to CMS Administrator Seema Verma, ADA President Chad P. Gehani and Executive Director Kathleen T. O’Loughlin shared the Association’s concerns that the initiative “would not meet the ADA’s funding and safeguard policy standards.”

“The ADA believes that Medicaid plays an essential role in a state’s oral health care safety net and is committed to ensuring that families have access to comprehensive and affordable health coverage, including oral health care coverage,” Drs. Gehani and O’Loughlin wrote. “Medicaid, our nation’s safety-net health insurance program, currently provides vital coverage to over 71 million Americans, including 35 million children.”

The letter also said the ADA opposes language in the CMS guidance mandating that routine non-pediatric dental services not be included as an essential health benefit for Affordable Care Act plans.

“Since adult dental services are not included as essential health benefits, states choosing this approach may have to eliminate existing adult dental coverage for adults covered under Medicaid expansion,” Drs. Gehani and O’Loughlin wrote. “Furthermore, the ADA views any potential future cuts to dental care as detrimental to the overall health of the adult Medicaid population since states are not required to cover dental benefits as they are for children.”

The Association also noted that because Medicaid costs are shared between the federal and state governments, there can be “significant differences between states on coverage of optional populations and benefits.”

“Under a block grant approach, the funding for a state’s Medicaid program would be determined up front and therefore put states at risk for additional costs to meet the needs of Medicaid enrollees,” Drs. Gehani and O’Loughlin wrote.

Currently, 37 states including the District of Columbia have expanded Medicaid eligibility. Of those, 35 provide a wide range of dental care for adults from comprehensive coverage to emergency care only.

“Demand for Medicaid dental services among children and adults will increase moving forward, regardless of Medicaid expansion. The rate of growth in demand depends on the level of adult dental benefits covered by each state and the number of uninsured individuals that qualify for Medicaid moving forward,” the letter concluded.

Also in a Feb. 5 letter, the ADA thanked Rep. Marc Veasey, D-Texas, for introducing a House resolution expressing disapproval over the guidance.
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