*Blog updated on 09/21/2023*

 

How did we get here?  

Throughout 2023, KOHC has monitored the adult Medicaid dental benefit expansion, summarizing the progression of this issue:  

  • October 2022 – Governor Beshear announces expanded dental benefits for adults on Medicaid including restorative treatment like fillings, crowns, implants, and dentures to begin in 2023. 
  • January 2023 – The Cabinet for Health and Family Services (CHFS) files emergency regulations to begin offering these benefits, including a rate increase for providers.  
  • February 2023 – The Administrative Regulations Review Subcommittee (ARRS) finds the regulations to be deficient. SB 65 is filed to rescind the regulations.  
  • March 2023 – SB 65 becomes law, following a veto-override from the legislature.  
  • April 2023 – New regulations are filed by CHFS to reinstate the expanded dental benefits.  
  • May 2023 – CHFS accepting public comments on the new regulations – only positive comments were received. ARRS finds the new regulations deficient.  
  • August 2023 – ARRS hears the new regulations again, no action taken.  
  • September 2023 – ARRS hears the new regulations again, no action taken. Recommendation made for Health Services Committee to hear the regulations.

Despite the deficiency finding in May, the regulations are currently active and Medicaid recipients are eligible for the expanded dental benefits. KOHC will continue to monitor this regulation and provide updates to membership and oral health stakeholders.  

Testimony shared by KOHC in the ARRS Committee meeting on 9/12/2023:  

Thank you Chair West and members of the committee.  

I am here today on behalf of the Kentucky Oral Health Coalition, a network of Kentuckians working to improve oral health in our state. I want to echo sentiments you have heard for many months in this committee about the importance of oral health care and coverage, especially for the Medicaid population in Kentucky. But I know this committee does not need to be educated on the reasons for oral health being prioritized in health plans, or the desperate need for dentists to be reimbursed at higher rates for the services they provide – you all know that and many of you have openly stated your support for those things.  

I am here today to urge this committee to consider the important details in finding a path forward for adult Medicaid dental benefits in Kentucky.  

The first is continuity of care – this concept has been lifted up throughout the discussions this year and continues to be critical to the 1.6M Kentuckians accessing the Medicaid program. We were encouraged to see changes made to Senate Bill 65 that ensured those in active treatment plans would be allowed to finish their course of treatment after regulations were rescinded and this continues to be just as important today. Hundreds of Kentuckians are in active treatment plans under the emergency regulations, and action to rescind these regulations could jeopardize their ability to complete that care. We are asking that you consider this reality when approaching a more permanent solution to oral health care in Kentucky. This also has impacted Medicaid providers around the state, many of whom have made the decision not to offer the expanded services due to the uncertainty around their permanency.  

The second is provider reimbursement rates – I know the members of this committee are well aware of the deficiencies in the dental fee schedule, especially prior to rate increases in 2023, but also those that persist in the current fee schedule. Many Medicaid dental providers are operating at a loss to provide care to the most vulnerable patients in their communities, and many others choose not to absorb the loss to their business to do so. The rate increases seen this year were welcomed by providers around the state, but they were simply not enough. I will not pretend to know what it takes to provide a root canal or make a set of dentures, as that is not my expertise, but I do urge this committee to talk to providers. Be diligent in understanding the true cost of providing this care, and ensure rates are set at an appropriate level. This includes examining discrepancies in the fees set by the Department for Medicaid Services and those paid by the MCOs. Ensuring providers see consistent, adequate reimbursements is critical to preserving and expanding the network of Medicaid providers in our state.  

We appreciate the work of this committee to consider the path to sustainable dental benefits for adults and ensure Kentucky retains qualified oral health providers who can offer services to all Kentuckians, including the most vulnerable in our communities. 

Testimony shared by KOHC in the ARRS Committee meeting on 8/8/2023: 

Thank you for the opportunity to speak to this committee today. I am here on behalf of the Kentucky Oral Health Coalition, which is a statewide group of citizens, parents, oral health providers, and other professionals with a goal of achieving optimal oral health for all Kentuckians.  

I am here today to speak in support of proposed regulation 907 KAR 001:126, which expands the covered dental services for adults accessing Medicaid in the state of Kentucky. Prior to the first expansion of these benefits in early 2023, adults accessing Medicaid benefits were severely limited in the care they could receive for oral health treatment and conditions – with many only able to access one cleaning per year and simple tooth extractions when a problem arose. For many years, this has been a reality for our most vulnerable Kentuckians, shaping an oral health landscape plagued by limited care options and unnecessary extractions. The need for comprehensive dental benefits is well-established in the Commonwealth, which ranks in the bottom five on several oral health indicators and has more adults over age 65 with no natural teeth than any other state. 

The proposed regulation we are discussing today aims to address the lack of treatment options for adults by adding covered services to provide restoration options such as fillings, dental implants, and dentures, in addition to ensuring two cleanings per year, which is in line with the recommended dental visit schedule.   

We believe the expansion of Medicaid dental services for adults is an important first step to improving the oral health and overall health of our population in Kentucky. Oral health conditions and loss of natural teeth significantly impact overall health and can lead to increased risk for other complications. We know that Medicaid-eligible adults are already experiencing significantly higher rates of diseases linked to poor oral health, such as cardiovascular disease, oral cancers, and substance use disorders, and their ability to effectively manage their disease is made considerably more difficult by a lack of access to necessary oral health care – both preventive and restorative.  

Ensuring adults have access to routine dental visits as well as restorative treatment not only improves oral health outcomes, it also reduces costs. States that offer comprehensive adult Medicaid dental benefits see a dramatic reduction in spending on ER visits for dental care each year. According to a study conducted by CareQuest Institute for Oral Health, in Kentucky in 2019 ER visits for non-traumatic dental conditions amounted to more than $44 Million, with Medicaid-enrolled Kentuckians ages 25–34 accounting for 65% of those visits.  

One of the goals outlined by the Kentucky Oral Health Coalition is improved access to care for all Kentuckians. We know access to care is a complex issue and means much more than the benefits outlined on a health insurance plan. Kentucky has experienced significant workforce challenges and the dental care field is no exception with many Kentuckians experiencing difficulty finding a provider, long wait times, and travel outside of their local area to receive oral health care. We were pleased to see increased reimbursement rates alongside the expanded benefits, ending more than 20 years of stagnant rates for our dental providers. These rate increases were absolutely necessary for providers and should be retained. However, without the option to provide restorative treatments outlined in this proposed regulation, dentists are limited to very few care options for patients. We are also hopeful that this increase will help bring more Medicaid-enrolled providers into the network over time. 

This expansion can offer an important first step toward providing comprehensive dental care for Kentuckians and addressing the growing oral health crisis that currently lends to absenteeism at work, costly ER visits, and higher rates of disease and substance misuse. 

 

Testimony shared from Dr. Kayla Fields, a dentist in Southeastern Kentucky and a KOHC member:  

My name is Dr. Kayla Fields. I currently serve as dental director for Grace Health. 

Grace Health is a Federally Qualified Health Center. We have 12 different locations spread throughout 6 counties in Southeastern Kentucky to provide access to quality health care. 

The counties we serve are Clay, Leslie, Knox, Whitley, Bell, and Laurel. Last year, Grace Health expanded dental services from being provided in a school-based setting only to opening a dental clinic in Hyden of Leslie County and in Manchester of Clay County. So far, over 75% of patients we have examined have tooth decay and approximately 70% of our patients have Medicaid. 

Our patients need coverage for regular, routine dental care, every 6 months as this is standard of care in dentistry. Checkups and cleanings are crucial to maintaining oral health and catching any issues early. 

Our patients need expanded coverage for services like dentures, as we are aware of the impact having a healthy, beautiful smile has on an individual’s confidence and well-being. It’s very rewarding, as a provider, to know you have helped someone reenter the workforce or advance in their career. It’s very rewarding to know that your patient isn’t paranoid to smile and feels more comfortable in social settings. So far, we have completed or are in the process of completing over 78 cases. This is 78 people edentulism can’t hold back anymore. 

One of those 78 people is a close family member of mine. A drug addict who has recently gone into recovery. We are in the process of making him a set of dentures. He told me that not having teeth makes someone automatically feel inferior in any situation. What a difference having dentures can make in his life and continued recovery! 

As an FQHC, it’s our goal at Grace Health to not only provide access to care, but to provide access to quality, compassionate care for the whole person. The expansion of dental services provided by regulation 907 KAR 001:126 strongly supports this effort.  

 

Have questions about coverage? Visit chfs.ky.gov/agencies/dms to contact the Department for Medicaid Services or contact your MCO directly.