Medicaid is the primary insurance program for low-income adult Pennsylvanians seeking both medical and dental coverage. Pennsylvania’s Medicaid program provides payment for dental services rendered to eligible recipients by dentists that are enrolled under the program. Under the Affordable Care Act, dental care for adults is not an essential benefit. In 2012, dental benefits were reduced for adult Pennsylvanians to basic dental care.
This policy analysis examines how reduced dental benefits have impacted adult Medicaid recipients in Pennsylvania and the various policy options that could potentially improve their access to oral health care. The policies examined were: expand Medicaid coverage for beneficiaries and increase dental reimbursement rates, extend the dental workforce to include dental therapists (midlevel providers), and institute a dental surveillance program. A literature review was conducted to determine the effectiveness of each of these policy options. Evidence from other states’ Medicaid dental benefits was utilized to determine political, economic and administrative viability. There is compelling evidence, which suggests that expanding Medicaid coverage, increasing reimbursement rates, and utilizing dental therapists may provide a solution for improving oral health care access to Pennsylvania’s adult Medicaid population. There are, however, not enough state-based data on Medicaid recipients’ self-perception of oral health status or their actual oral health status, dentists’ beliefs regarding Medicaid, and oral health indicators in Pennsylvania. This information indicates that developing an ongoing oral health surveillance program should be the first step to improve oral health access for adult Medicaid recipients.
Presentation: 15 minutes
Dixon, Renee, "An Oral Health Policy Analysis: Improving Dental Care for Pennsylvania's Adult Medicaid Recipients" (2015). Master of Public Health Capstone Presentations. Presentation 145.