Thousands of Marylanders just gained access to critical oral health care coverage

It was the tragic story of 12-year-old Deamonte Driver — a boy who died from an untreated tooth infection that spread lethal bacteria to his brain — that first compelled Maryland advocates to fight to expand dental coverage to low-income children in 2007.

As advocates made meaningful advances in dental coverage for children in Maryland, the organization at the forefront of this work, the Maryland Dental Action Coalition (MDAC), then turned its attention to expanding dental coverage for adults on Medicaid.

And now, more than 15 years after MDAC and the advocate community began its work, on January 1, 2023, over 800,000 Maryland Medicaid adult beneficiaries finally gained access to comprehensive dental coverage.

This is a significant victory for Maryland and the many low-income adults and people with disabilities who rely on Medicaid for critical health care services.

And it should serve as a call to action for other states to follow suit and finally make access to oral health care more equitable for the millions of people across our country who currently lack this coverage.

According to data from CareQuest Institute for Oral Health's State of Oral Health Equity in America survey, 77 million adults in the US lack dental benefits — three times the number of people without medical insurance. This lack of coverage disproportionately impacts Black and Latino people, tribal and rural communities, and people with disabilities.

The lack of dental benefits available to Medicaid-eligible adults contributes to this gap in coverage, as the provision of dental coverage to adult enrollees is currently optional for state Medicaid programs. Through the remarkable work of community advocates and policymakers, states such as Maryland have acted to strengthen their Medicaid programs by adding adult dental coverage.

However, while most states provide at least emergency adult dental benefits (defined differently by states), many do not offer dental care beyond emergency procedures or have no coverage at all. This leaves adult Medicaid enrollees needing dental care with the untenable choice of going to an emergency department or suffering through pain.

The case for the implementation of Medicaid adult dental benefits is beyond the moral imperative. If better and improved health for the population is the charge and mandate of the state, and if the vast disparities among the socioeconomically disenfranchised and historically marginalized populations are well-documented, then it behooves the state to address access to care among those most impacted and disproportionally represented among the Medicaid enrollees.

Additionally, lack of dental insurance is a major contributing factor to the disparities in overall health outcomes, making Medicaid adult dental benefits expansion a powerful lever in achieving equity in oral and overall health.

Case in point, Medicaid-eligible adults also experience significantly higher rates of diseases linked to poor oral health, such as cardiovascular diseases, oral cancers, and substance use disorders, compounded by a lack of access to necessary preventive oral health care.

The expansion of Medicaid coverage also has undeniable economic benefits. Nearly 80% of emergency department dental visits, which cost the health care system $2.1B annually, are preventable and addressable in a dental office.

In Maryland, a CareQuest Institute study revealed that the state was spending $10 million per year for these visits for Medicaid patients, which are costly, ineffective, and largely avoidable with accessible preventive dental care.

Additionally, adults who obtain dental coverage through Medicaid report improved oral health and employability. CareQuest Institute research conducted before the pandemic found that ensuring dental care access to all working adults would create $14.2 million in federal tax revenue and save $7.9 million in unemployment benefits.

While the progress in Maryland is a monumental milestone in addressing equitable access to care, there is much work left to be done. MDAC and the advocate community have shifted their focus to implementation, including working with partners and stakeholders on significant consumer education and an outreach campaign to provide accurate information and ensure enrollees are aware of the dental benefits and help them gain access. They are also working with the Maryland State Dental Association and other partners to recruit providers to participate in the state's dental program, Maryland Healthy Smiles, to cover the increase in people seeking dental care.

By extending additional dental benefits to adults on Medicaid, Maryland policymakers recognized that oral health impacts overall health, wellness, and economic security. This has been the culmination of an arduous journey that began in 2007 and is a critical step toward improving access to care and creating an equitable oral health system for the people of Maryland—a model which we hope can be replicated nationwide.

Kaz Rafia, DDS, MBA, MPH, is Chief Health Equity Officer at CareQuest Institute for Oral Health. Mary Backley is the CEO of the Maryland Dental Action Coalition.