Various factors, including expanded federal COVID-19 relief funding, led to surpluses in several states’ budgets in the 2021-22 legislative season. This environment has enabled many state legislatures to focus on improving their dental Medicaid programs for dentists and patients. This year alone, with state dental societies highly engaged on the issue, at least 14 states have positively updated their laws regarding dental Medicaid, and another three states currently have pending legislation.
The ADA believes that ensuring states provide comprehensive dental services to all Medicaid beneficiaries is an important issue for dentists, the dental profession and patients. On the federal level, the ADA supports the Medicaid Dental Benefits Act of 2021, which would make comprehensive dental care a mandatory component of Medicaid coverage for adults in every state, similar to comprehensive dental coverage for children in Medicaid.
“For too long, dental benefits under Medicaid, particularly for adults, have been like an ‘on/off’ switch for patients, with states turning the switch off whenever budgets get tight. This inconsistency is confusing and unfair to dentists and patients alike,” said ADA President Cesar R. Sabates, D.D.S.
“I am so gratified to see the many states acting on this issue on behalf of patients. Doing so will reduce racial disparities and inequities in chronic disease prevalence and promote maternal health. That said, our final goal must be sustainable adult dental benefits in Medicaid, providing continuous access to those who need it most. We’re not there yet, but what’s been done in these states represents great progress.”
These 14 states have enacted laws regarding dental Medicaid:
Lawmakers in the state approved a 25% dental Medicaid fee increase.
The Florida Dental Association advocated to keep the state’s dental Medicaid program from being merged into the state’s medical managed care Medicaid program. The state association accomplished this despite a strong push from state Medicaid officials and in doing so, ensures that Florida’s Medicaid program will continue to be well-funded and accessible.
The state budget provides for an increase in reimbursements for select dental Medicaid services.
The state budget includes $10 million to increase rates for preventive dental services.
A new law extends adult enrollees’ dental coverage from emergency-only to more comprehensive care.
A new law now requires Medicaid to cover dental care for adults with intellectual or developmental disabilities who reside in intermediate care facilities.
A new law in Maryland adds diagnostic, preventive, restorative and periodontal services for adults whose annual income is at or below 133% of the federal poverty level. Previously, the state had no dental coverage for adult enrollees aside from pilot programs. Funding is also included to raise reimbursement rates for dental services.
The state approved fee increases for restorative services performed on Medicaid patients.
Lawmakers adopted one of the largest dental Medicaid fee increases in the state’s history this year. Reimbursement rates will now be set at 80% of the average 2022 fees, making them more in line with fees paid in commercial dental plans.
State lawmakers adopted a 10% dental Medicaid fee increase and also eliminated the $750 annual spending limit for adult dental services. Also adopted was the plan to combine the state dental program into the state’s medical managed care organization.
South Dakota lawmakers approved the plan to set dental Medicaid fees at a percentage of normal and customary fees with the hope that more dentists will be able to participate in the program.
Following the passage of its state budget, Tennessee’s Medicaid program will begin adding comprehensive dental coverage for the state’s 600,000 adult enrollees in 2023. Additionally, fees will increase more than 6.5% for preventive, endodontic and other services. The state also funded a pilot program to bolster access frameworks by funding dental school programs serving low-income patients, enhancing the use of community dental health coordinators, incentivizing dentists who agree to practice in rural areas, and also helping to cover costs of enrollees’ transportation to dental appointments.
The state budget included $1 million dedicated to dental Medicaid funding. The state also eliminated limitations on dental preventive services in Medicaid.
The state budget deal includes a 30% fee increase in provider dental Medicaid reimbursement rates.
These three states have pending legislation:
The state is moving to add more comprehensive adult enrollee dental coverage. Currently there are emergency-only adult benefits.
The proposed executive budget includes an investment to replicate the success of the Healthy Kids Dental for all Medicaid enrollees in the state through a single combined managed care contract, extending access to dental care for over 3 million Michiganders. The final budget bill has yet to be agreed upon by the Michigan House and Senate.
Lawmakers voted to enact a law extending adult dental coverage beyond emergency-only. Final approval by the governor would be the last step in securing this benefit.
Follow all of the ADA’s advocacy efforts at ADA.org/advocacy.
ADA highlights state advocacy wins to improve dental Medicaid
At least 14 states finish 2022 state legislature season with victories