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Md. legislature takes a step to add dental care to Medicaid

(The Daily Record / Maximilian Franz)

(The Daily Record / Maximilian Franz)

Maryland could begin extending dental care to adults enrolled in Medicaid under a pilot program the General Assembly passed Saturday.

Advocates believe that improving oral health could drive down emergency room visits and reduce the costs associated with chronic issues like diabetes and heart disease.

“Many Maryland adults face serious financial obstacles to obtaining dental care,” Salliann Alborn, chair of the Maryland Dental Action Coalition’s policy committee, said in a statement. “This pilot program is an important step forward in demonstrating that a Medicaid adult dental benefit that enables adults to establish a dental home, obtain preventive care, and avert costly dental conditions is a good investment in health outcomes and the fiscal health of Medicaid.”

The legislation establishing the pilot program passed the Senate unanimously last month and passed the House unanimously Saturday. The bill still needs the approval of Gov. Larry Hogan.

While children on Medicaid in Maryland do receive dental coverage, that coverage does not extend to adults, with the exception of emergency dental procedures in the emergency room.

A study by the dental action coalition found that in 2016 there were 42,327 emergency room visits for chronic dental conditions among adults. Those visits cost an average of $537, totaling $22.7 million.

For Medicaid alone, the total cost was around $10 million.

The bill attracted the support of the Maryland Hospital Association under the belief that finding a way to provide dental care could drive down costs, especially for a hospital payment system that incentivizes keeping hospital visits down.

“Maryland’s hospitals support efforts to expand coverage of needed health care services, including dental coverage for adults,” the association wrote in its position paper on the bill. “Doing so yields not only important benefits for patients, but would also mitigate lengthy wait times in hospital emergency departments.”

For the pilot program, the state needs to seek federal approval to include dental care in Medicaid. If granted, the program could begin as soon as early 2019.

The pilot could limit its population based on dual enrollment in Medicare and on age while also capping the total number of participants.

But next year the state may have to consider some additional changes to help the newly enrolled take advantage of dental care, said Robyn Elliott, a consultant for the dental coalition.

“There could be a community health center that wants to expand its capacity because now they’ll be able to collect reimbursements because it’s financially viable,” she said. “Looking at support for these providers, expanding their capacity, I think, probably will be a very important priority.”

While expanding dental care has attracted attention for the possibilities of reducing emergency room costs, studies have also shown that dental care has a chance at reducing health costs associated with chronic conditions, including diabetes, high blood pressure and heart problems.

Savings in those areas could be advantageous to the state as it moves to the next phase of its waiver with the federal government, which will look more holistically at the cost of care, including in primary care and other out-of-hospital settings.

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