This post originally appeared as an op-ed in the Courier Journal on March 8th, 2023.

On January 1, 2023, a new provision went into effect in Kentucky ensuring Medicaid adult beneficiaries in the state have comprehensive dental coverage. Advocates in Kentucky have long fought for this coverage because it helps narrow the health care equity gap for more than 900,000 underserved Kentuckians. This is a significant victory for many low-income adults and people with disabilities who rely on Medicaid for critical health care services. It is also a victory for Medicaid dental providers in Kentucky, who will see increased reimbursement rates for their services.

These additional Medicaid benefits and the increased reimbursement rates will help Kentuckians, including those with substance use disorders and in recovery, enter and remain in the workforce free from dental pain.

The expansion also ensures access to necessary dental care for pregnant women, which is critical to a healthy pregnancy and can impact both birth and children’s oral health outcomes.

The case for strengthening dental coverage

Lack of dental insurance significantly contributes to disparities in overall health outcomes, making Medicaid adult dental benefits expansion a powerful mechanism to advance equity in oral and overall health. Not only do Medicaid-eligible adults experience significantly higher rates of diseases linked to poor oral health, such as cardiovascular diseases, oral cancers and substance use disorders, but their ability to effectively manage their disease is made considerably more difficult by a lack of access to preventive oral health care.  

The expansion of Medicaid coverage also has undeniable economic benefits.

Emergency department dental visits, 80% of which are preventable, cost the nation’s health care system more than $2 billion annually. In Kentucky, a recent CareQuest Institute study revealed that the state was spending $44 million per year for these largely preventable or avoidable dental visits. Additionally, adults who obtain dental coverage through Medicaid report improved oral health and employability. CareQuest Institute research conducted before the pandemic found that ensuring dental care access to all working adults would create $14.2 million in federal tax revenue and save nearly $8 million in unemployment benefits.

By maintaining this Medicaid dental coverage for years, Kentucky will reap the benefits oral health has on overall health, wellness, and even economic security.

Lack of dental coverage is not just a Kentucky problem

According to data from CareQuest Institute for Oral Health’s State of Oral Health Equity in America survey, 77 million adults in the US are without dental benefits — three times the number of people without medical insurance. This gap in coverage disproportionately impacts Black and Latino people, tribal and rural communities, and people with disabilities.

Not surprisingly, the lack of dental benefits for Medicaid-eligible adults contributes to these disparities, as the provision of dental coverage to adult enrollees is currently optional for state Medicaid programs. Additionally, nearly one-third of all states do not offer dental care beyond emergency procedures or have no coverage at all. This leaves adult Medicaid enrollees with dental disease with the untenable choice of going to an emergency department or suffering through pain. Kentucky has now become a leader in strengthening Medicaid by expanding adult dental coverage.

Oral health advocates take on implementation in Kentucky

While the passage of the Medicaid dental provision is a monumental milestone in addressing equitable access to care, the work is not yet done to ensure hundreds of thousands of Kentuckians receive much-needed oral health care.

The Kentucky Oral Health Coalition and the advocate community have turned their attention to the effective implementation of the law by collaborating with the Department for Medicaid Services and focusing on educating Medicaid enrollees about their new benefits and how to access care. They are also working with community dental leaders and other stakeholders to expand the dental workforce statewide in advance of the anticipated increase in Medicaid recipients seeking care. Their efforts include outreach to dental providers to raise awareness about the significant reimbursement rate improvements associated with the recently added dental services.

Ultimately, the expansion of dental coverage is a critical step towards a healthier and more productive Kentucky by improving access to care and creating an equitable oral health system for its people — something that we believe the citizens of this great state deserve.

Kaz Rafia, DDS, MBA, MPH is Chief Health Equity Officer at CareQuest Institute for Oral Health. Stephanie Poynter, DMD is the Dental Director at Family Health Centers, Inc. and Chair of the Kentucky Oral Health Coalition.