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State Spotlight: Data Reinforces the Need for Dental

In 2017, Maryland Senate Bill 169 authorized Maryland Dental Action Coalition (MDAC) to produce a report to evaluate the cost of dental related emergency department (ED) visits for adults.

At the time of the analysis, Maryland Medicaid only offered emergency dental services for non-pregnant, non-disabled adults (ages 21 and over) enrolled in Medicaid.

According to Mary Backley, Executive Director of MDAC, “Emergency rooms are unable to treat the causes of dental pain, so they treat the symptoms and send patients home with antibiotics, pain medications, or referrals for dental services that they may not be able to afford. Although dental professionals strive to help at-need patients through low-cost care, or through non-profits that offer free services, it is simply not enough” and, according to the report’s findings, ED visits for dental related conditions has come at a great cost to the state, patients, hospitals, and taxpayers.

In fact, across the nation, it is estimated the impact of ED utilization for dental needs is around $1.8 billion, with Medicaid taking on the largest burden and paying nearly 41% of these costs.

Some Key Findings:

  • In FY2016, there were 42,327 ED visits for chronic dental conditions among Maryland adults with an average charge of $537 and a total charge of $22.7 million.
  • There is a disproportionate burden on Medicaid. Medicaid paid for 53% of ED visits for chronic dental conditions with an average charge of $446 and a total charge of nearly $10 million to the state.
  • EDs are not equipped to treat dental conditions and comes with a much higher rate of readmission than other conditions. 25% of them returned to the ED within a year with similar complaints – a majority return within 15 days.
  • Geography matters. Baltimore City and the rural counties of eastern shore Maryland have the highest rates of ED visits for chronic dental conditions.

The results indicated an ineffective and costly system due in large part to a lack of preventive dental care. Armed with data, dozens of oral health stakeholders descended upon the state’s capital, Annapolis, to provide written and delivered testimony to educate members of the Maryland General Assembly and advocate on behalf of a preventive, adult Medicaid oral health benefit. In addition, op-eds and editorials published in targeted member districts called attention to the impact oral health issues have on the community.

Following this concerted effort, both houses of the Maryland General Assembly unanimously passed SB 284, legislation establishing the Maryland Medical Assistance – Dental Coverage for Adults – Pilot Program for individuals between the ages of 21 to 64 who are dually eligible for both Medicare and Medicaid. According to the Maryland Department of Health, it is estimated that approximately 35,510 individuals will gain dental coverage through this pilot program.

According to Mary Backley, a Medicaid adult dental benefit enables adults to establish a dental home, obtain preventive care, and avert costly dental conditions, which according to MDAC and its coalition partners, members, and stakeholders, “is a good investment in adult health outcomes and the fiscal health of Medicaid.”

The pilot program is set to be put into effect as early as January 2019 and supporters hope the program will successfully run for 3-5 years in order to collect data to support the need for a more permanent solution – a comprehensive Medicaid adult dental benefit.

Using the same data-driven strategy that helped push SB 284 and the pilot program to fruition, MDAC, in collaboration with its coalition partners, members, and stakeholders, will chart the course forward for win-win systems change solutions that improve the health of both Maryland adults and the state budget.

 

The Wisdom Tooth Project is a program of Oral Health America