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Editorial: Shouldn’t Medicaid also cover dental care?

In an interview on New Hampshire Public Radio this week, Health and Human Services Commissioner Nick Toumpas suggested a new wrinkle in the already complicated debates about expanding Medicaid eligibility in the state and the transition to a managed care system to run New Hampshire’s health services program for the poor.

Adults who qualify for health-care coverage under Medicaid, Toumpas said, should receive a dental benefit, much as children do now. “One of the things we want to do is look at an adult dental Medicaid benefit. The whole idea would be to look at the individual in a more holistic way,” Toumpas said. Adding such a benefit has been a regular (but so far unsuccessful) budget pitch to state lawmakers over the years.

It’s hard to argue with his logic. Routine and preventive dental care is a basic pillar of good health. Keeping your teeth and gums in good repair, as dentists regularly lecture us, helps your overall health. Ignoring them not only imperils your oral health but can also create myriad related health concerns.

There are economic arguments in Toumpas’s favor, too. For individuals, poor teeth can be a very real barrier to employment: a job applicant with a mouthful of discolored or missing teeth simply won’t make a good impression on a potential employer. (Consider a short-lived measure in Massachusetts which had Medicaid paying for fillings, but only those in the front of the mouth. The rationale: healthy front teeth were most important for getting and keeping jobs.)

And for the government, helping to pay for preventive dental care for Medicaid recipients may well mean avoiding the far costlier emergency dental care that New Hampshire does cover these days.

Medicaid, which is a joint federal-state program, requires dental coverage for children but not for adults. As a result, the dental benefits offered to adults varies greatly from state to state. Some offer no dental coverage and some, like New Hampshire, cover only emergency services. Others are more generous, covering extractions and some preventative, diagnostic and restorative dental services.

Because dental coverage for adults under Medicaid is not required by the federal government – and, so far at least, the Affordable Care Act won’t change that – it has been an easy target for state budget-cutters across the country in lean years. Last year, for instance, Illinois, once among the most generous states, cut dental benefits dramatically.

But there has also been movement in the other direction. Colorado, for instance, which never had a Medicaid dental benefit before, will soon allow each adult up to $1,000 in everyday dental benefits such as exams, cleanings and scheduled work each year. Washington state lawmakers approved a similar plan. In Massachusetts, the plan that now covers fillings for just front teeth will soon start covering the entire mouth.

The split between general medical coverage and dental coverage – both in the Medicaid program and in the world of private insurance – has always seemed like a false division. Health is health, after all. We’d encourage New Hampshire lawmakers who are already wrestling with issues of health coverage for the poor to think hard about Toumpas’s suggestion. Of course, a Medicaid dental benefit for adults would need to be more than just symbolic. Already many dentists are reluctant to care for Medicaid patients because the government reimbursements are low. If legislators are interested in truly helping poor residents obtain regular, preventative dental care, that issue too will need to be addressed.

How does the CM propose we pay for this along with Obama's newest venture of a future of free college.

Conservatives used to at least think like businesspeople. Like what is the benefit in exchange for this tax / fee / whatever? Then they would conclude that it was worth the cost or not (more frequently "no" than liberals, but still sometimes "yes"). Modern conservatives look at the cost only. If is above zero, it's an automatic "no." Hell of a way to run a country or a business.

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