Front Line Innovations – Policy Changes to Improve Oral Health

COVID-19 has fundamentally changed the face of oral health care. Virginia Health Catalyst is highlighting innovations in oral health through the Front Line Innovations blog series. This week’s blog from Pat Finnerty, Catalyst’s policy committee chair and a former director of the state’s Medicaid program looks at federal policy innovations to improve access to oral health care in Virginia.

In mid-March the Commonwealth was poised to enact a budget that vastly improved access to health care services for vulnerable Virginians. It included funding for a comprehensive adult dental benefit – something I have been a strong supporter of since my days as the state’s Medicaid director. Medicaid beneficiaries were finally going to have access to services that not only improve their oral health, but also improve the management of diabetes, heart disease, and other chronic conditions. In short, their overall health would be improved significantly. But as March drew to a close, the effects of COVID-19 were crystallizing. All new spending, including funds for the dental benefit, was unalloted in the budget. And all of this was (and is) happening when more Virginians than ever will need to rely on Medicaid for their and their family's health care coverage – 30,000 adults have enrolled in Medicaid since the state of emergency was declared. Luckily there are policy levers that can help.

Medicaid is a state and federal partnership. Through this partnership, Congress can affect the vitality of state budgets and the health of people across the country by increasing the federal portion of Medicaid funding and by enacting additional policy changes that support dental coverage and recognize the importance of comprehensive health care that includes oral health.

To that end, this week over 200 organizations from across the nation sent a letter to members of Congress advocating that the following items be included in the next stimulus package:

• An increase in the Federal Medical Assistance Percentage (FMAP) by 12%
• An increase of the FMAP for Medicaid dental services by 5%
• $75 million to fund state health departments and oral health programs to support oral health infrastructure

What is FMAP and why does an increase help Virginia?

Funding for each state’s Medicaid program comes from both the state and federal governments. For every dollar paid by a state, the federal government “matches” that amount with a certain percentage of federal funds. The “FMAP” or “match rate” for each state is based on its per capita income. States with a lower per capita income receive a higher match rate; states with a higher per capita income receive a lower match rate. In Virginia, the match rate that applies to the majority of our Medicaid program costs is 50% by the commonwealth and 50% by the federal government.

In the second stimulus package passed in March, Congress increased the FMAP by 6%. This means for the duration of the national public health emergency, the federal government’s FMAP in Virginia is 56%. This is good news, as it frees up state dollars, but it is not enough. An FMAP increase of 12%, as requested in the letter referenced above, is in line with the approach taken during the 2008 financial crisis. I was the state Medicaid director then, I know first hand how crucial this was to the commonwealth. A 12% FMAP increase will provide Virginia additional flexibility to support key programs; an additional 5% FMAP increase to support dental programs would be a game-changer in addressing overall health and oral health.

What you can do to support oral health

First and foremost contact your Congressional representatives! The next few weeks are critical, health advocates must make sure our federal representatives understand the urgent need for a long term FMAP increase and the importance of shoring up state oral health programs. As we head into the summer, state policymakers in Virginia will begin to address the unalloted funding in the budget; If these federal policy provisions are in place, especially an FMAP increase, Virginia will have more flexibility and perhaps the ability to fund some of the initiatives, including adult dental, we were all celebrating just a few short months ago.

More Virginians than ever are counting on us to create a health care system that meets their oral health and overall health needs. In addition to contacting your representatives, join me in advocating for oral health by signing up for the Grassroots Advocacy Team. As a member, you’ll receive policy updates and templates for outreach to your elected officials. Together we can create a stronger health care system in Virginia.