The majority of states in the U.S. currently provide dental care to adults with I/DD under Medicaid; however, 12 states currently do not offer these services and some only provide emergency dental care. A new report released by the National Commission on Disability (NCD) examined the financial impact and potential benefit of providing oral health care for adults with I/DD, resulting in a recommendation that all states extend coverage immediately. Here, we take a look at their key findings and primary calls to action.
The NCD is a nonpartisan, independent federal agency whose role is to advise federal agencies, Congress and the President on matters involving disability policy. A similar focus on issues around oral healthcare has been included in their prior publications, which include:
- February 2022: Health Equity Framework
- August 2019: Recommendation to require all dental schools to train students on managing oral care treatment for people with I/DD
- November 2017: Neglected for Too Long: Dental Care for People with Intellectual and Developmental Disabilities
Central Research Questions
The NCD’s March 2022 report is entitled “Medicaid Oral Health Coverage for Adults with Intellectual & Developmental Disabilities – A Fiscal Analysis.” The report was written to: 1) share research findings from their ongoing research into oral health care for adults with I/DD; and 2) to provide recommendations for the 12 states currently not offering dental benefits for this population.
The agency noted its motivation for the report arose from the central research question:
“[S]hould the Centers for Medicare and Medicaid Services require all state Medicaid agencies to implement Medicaid reimbursement and payment policies that promote access to dental care for adults with I/DD”?
This question led the agency to examine the following:
- The relationship between Medicaid state dental benefits, state waivers, and receipt of oral health care for adults with I/DD;
- The estimated cost of providing basic dental care within the 12 states where it is currently not covered under Medicaid;
- The potential cost savings of providing basic dental benefits under Medicaid;
- How to improve access to oral health care for adults with I/DD;
- Strategies currently proving effective for expanding care being used by state and private providers.
Findings
The NCD noted several key findings, which included a clear indication that providing dental care to adults with I/DD is highly cost-effective because preventable oral health conditions are associated with (and are often a precursor to) more serious health conditions, such as diabetes, lung cancer, cardiovascular disease, and dementia.
Their analysis indicated the total cost of providing “extensive medical benefits” in the 12 states where they are currently not offered would be roughly $19.6 billion, with the states only covering $7.3 billion of the total cost. Yet, those costs would be more than covered by the elimination of emergency room visits, hospital admission requirements and ongoing treatment costs required by the chronic diseases caused by poor oral healthcare.
“NCD’s estimates federal and state governments combined would realize a ROI of approximately $7.7 million beyond recovering the initial cost, annually, and the share of that ROI for those 12 states would total close to $3 million, annually.”
Additional findings included:
- Almost 4.5 million adults with I/DD, out of the approximately 7.3 million in the U.S., access health coverage through Medicaid.
- There is no uniformity in how Medicaid provides dental coverage to adults with I/DD, and 12 states do not provide basic dental services.
- Compared to adults without I/DD, adults with I/DD experience poorer dental health, as well as greater barriers to accessing oral health care.
NCD Calls To Action
The NCD identified several specific recommendations aimed at addressing health disparities and health equity issues for adults with I/DD. These included:
- Ensuring all states add dental benefits for adults with I/DD;
- Prioritizing types of care and target populations to include for coverage using available data from and evaluations from existing waiver programs;
- Funding programs that address barriers to oral health care for adults with I/DD, which could include:
- Incentivizing dental providers through continuing education
- Providing programs to train caregivers on Improving daily oral care
- Improving education for adults with I/DD on how to maintain good oral hygiene
- Addressing barriers related to transportation and coordination between Developmental Disabilities agencies and Medicaid providers; and
- Conducting additional research under the U.S. Department of Health and Human Services, through the Administration on Community Living, on how best to reduce the need for oral health care in operating rooms.
The NCD’s next research topic will focus on “why providers choose not to participate in Medicaid programs and waivers that facilitate the treatment of patients with I/DD and potential incentives to encourage participation.”
To read the NCD’s full PR statement, click here.