DMAS Study Highlights Need for Dental Benefit

A study released today by the Virginia Department of Medical Assistance Services (DMAS) found a high usage of the emergency department (ED) for dental issues among Medicaid recipients.

Currently, Virginia’s Medicaid program does not provide a comprehensive dental benefit for all enrollees. In 2018, nearly 16,000 Medicaid recipients visited the ED roughly 19,000 times for dental related issues.

Some of the key findings from the report include:

  • Most of the ED visits were for adults: Virginia’s Medicaid program does not offer a comprehensive dental benefit for all adults; as a result low-income adults often forgo dental care until the pain or infection is at a crisis level. Nearly 1/3 of adults enrolled in Medicaid cited access to dental care as their biggest unmet need.
  • More than half (52%) of the ED visits were for non-traumatic dental conditions: These visits were for dental conditions that could have been treated, or even prevented, at a dental clinic. For example, the ED treated toothaches and loose teeth, both of which can be treated earlier if a dental benefit was available. 50% of Virginians put off dental care because of cost, and adults of color are disproportionally more likely to go without care than their white peers.
  • One-third of Medicaid recipients who used the ED for dental issues used it more than once: DMAS’ study found that one-third of the individuals who went to the ED for dental issues went back multiple times, anywhere from two to 19 visits. Adding a comprehensive adult dental benefit to Virginia’s Medicaid program can reduce avoidable ED visits, which will not only reduce costs for the state but improve the health of Virginians and help address the opioid epidemic. Previous studies have shown that a typical emergency department visit costs Medicaid an average of $790. That would translate to $15 million in costs to the state Medicaid program for an avoidable issue.

This study further underscores the important overall health impact a comprehensive dental benefit would have for all adults enrolled in Medicaid. By ensuring Virginians are able to access routine and preventive dental services when they need them we can improve both the oral health and the overall health of Virginians. From better managing chronic diseases like diabetes, to ensuring Virginians are able to get and keep a job, a comprehensive dental benefit is vital to a healthier Virginia. An adult dental benefit will also support the efforts of DMAS to curb substance use disorder; studies show that adults who receive comprehensive dental care during substance use disorder treatment are far more likely to complete treatment, be employed six months after treatment ends and their recidivism rate is reduced dramatically.

Show your support for an adult dental benefit by registering to attend Virginia Health Catalyst’s Legislative Action Day on January 28, and by sending postcards to your legislator.