It is time to prioritize oral health care for everyone

Whether you consider it part of your regular health maintenance or a bit of a chore, going to the dentist — and even having access to oral health care — is a crucial indicator of a person’s health.

Yet oral health care has consistently been treated by our health system as non-essential and separate from overall health. Because of this, individuals in communities across the U.S. struggle to access basic oral health care, including nearly 70 million adults who lack dental insurance.

A state’s priorities are reflected in its policies, and dental coverage was not a priority across the U.S. for years. Finally, that notion seems to be changing — so much so that we are experiencing the most significant growth in the number of state Medicaid programs offering adult dental benefits in recent decades, including Utah. In fact, between 2020 and 2022, nearly half of all states expanded their Medicaid adult dental benefit offerings.

As is often the case when sweeping policy change is necessary, this was long overdue. While states are required to provide comprehensive dental benefits for children covered by Medicaid and the Children’s Health Insurance Program (CHIP), dental coverage for adult Medicaid beneficiaries is optional. Without additional support from the federal government, states are often faced with difficult budgeting decisions that limit Medicaid adult dental benefits, forgo offering the coverage altogether or prioritize other health care spending.

Count Utah among the states overdue for a change.

While the state has offered adult dental benefits to certain groups of Medicaid beneficiaries, such as those who are pregnant, disabled or over 65, the state recently passed legislation this spring to provide coverage to all Medicaid adults for the first time. This new coverage will take effect in 2024.

Utah joins several states nationwide in taking crucial steps toward increasing access to oral health care. According to CareQuest Institute for Oral Health’s recently updated Medicaid Adult Dental Coverage Checker, which highlights the progress advocates and policymakers have made to expand adult dental benefits in the past few years, eight states now offer an extensive Medicaid adult dental benefit. That’s double the four states that boasted this in 2020.

It’s not a coincidence that this marked shift in progress coincided with the COVID-19 pandemic, which exposed the deep systemic inequities in our health system. Inequities within oral health, like inequities in other areas of society, are correlated with income and have a racial dimension.

For example, one CareQuest Institute study showed that 65 percent of respondents who lost their health insurance due to job loss or change in benefits caused by the COVID-19 pandemic had one or more oral health symptoms and did not get any treatment. And, the lower a person’s income, the higher the likelihood of having an oral health symptom in the last 12 months. We also know that Black adults are 68 percent more likely to have an unmet dental need than white adults. These factors, combined with broad public support for providing extensive dental benefits within Medicaid, helped improve access to care for thousands of individuals in Utah and across the country.

What makes this policy change particularly impactful? In short, it benefits everyone.

Numerous studies show that Medicaid adult dental coverage lowers overall health care spending on chronic disease management and emergency department usage. Emergency department visits alone cost an estimated $2.1 billion per year, and research indicates that nearly 79 percent of these visits could be addressed in a dental office — a potential savings of up to $1.7 billion per year. It also boosts oral health outcomes for patients and increases employment opportunities.

We applaud and congratulate Utah on taking this important step toward offering expanded Medicaid dental benefits to adults 21 and older. This progress would not have been possible without the steadfast commitment of the University of Utah School of Dentistry, policymakers and advocates at the state and local levels. As we enter the new year, we encourage Utah to continue moving forward on the implementation of the new benefit and to monitor progress on the utilization of the benefit and how it is improving the health and well-being of beneficiaries.

While Utah has added itself to a growing list of states making significant progress to increase access to oral health, there also needs to be dual action between the federal and state levels. Congress must pass broad legislation encouraging federal action to include oral health care in all state Medicaid programs. It is time to prioritize oral health and provide whole-person health care for every American.

Health benefits aren’t a yes/no proposition but a continuum. There is a big difference between dental coverage for emergencies only and a benefits package that includes a full spectrum of preventive and restorative dental care with no annual maximum. And those differences can be felt in ways that last a lifetime.

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Matt Slonaker, JD, is the Executive Director at Utah Health Policy Project and Dr. Kaz Rafia, is the Chief Health Equity Officer at CareQuest Institute on Utah's expansion of medicaid adult care benefits.