My Turn: The hidden bite of N.H.’s Medicaid expansion, and how we can fix it

For the Monitor
Published: 2/24/2019 12:25:12 AM

With the Democrats in the majority, lots of sexy topics are floating around the State House right now – paid family and medical leave, taxing carbon, gun law reform – but I’ll tell you what gets me excited: dental care. To be precise, House Bill 692, extending dental benefits to adult Medicaid recipients. This is a great idea that should be passed with bipartisan support.

The original Senate bill that expanded Medicaid in 2014 passed the Senate with votes from both parties, but didn’t include dental care. Unfortunately, when I recently mentioned House Bill 692 to a colleague in the minority Republican Party, he immediately rejected the idea as just another unnecessary state expansion. I beg to differ.

Nobody disagrees that Medicaid should be more like a springboard than a safety net. For most people, it’s a temporary solution until they are gainfully employed and insured through their employer, or until their own business becomes successful. To become gainfully employed or to build your own business, however, requires you to succeed in gaining customers or acing a job interview. Try doing that with missing teeth.

Studies have shown that when we encounter people who clearly have inferior dental health, rightly or wrongly we make judgments about their intelligence and level of achievement.

Children on Medicaid have access to dentists; adults, not so much. In fact, an adult Medicaid enrollee is covered only for an emergency extraction. Ouch. This is kind of crazy, particularly given that Medicaid recipients in New Hampshire must now either work 100 hours a month or take part in similar, broadly defined, “community engagement.”

Miss work because of a toothache or other oral health issue and you might find yourself falling short of the required 100 hours per month. So you’d lose the qualification for Medicaid coverage – and still need to see a dentist that you can’t afford.

Furthermore, poor dental hygiene can lead to far more dangerous and costly medical conditions.

Gum infections are associated with an increased risk of cancer and cardiovascular disease. Your choice: cleaning at the dentist or a regimen of chemotherapy? We all know which we’d pick as individuals, but as a state we should choose the dental cleaning, too – it’s a far more cost-effective use of funds.

I believe including dental care in our Medicaid expansion is a necessity, and HB 692 is the best start. I say start because the reimbursement rate for dentists still warrants conversation.

Despite this, the New Hampshire Dental Society is on board thanks to the tenacious work of the New Hampshire Oral Health Coalition, a group they are a part of and a vital player in this process. And ABLE NH, representing the developmental disabilities community, is equally supportive.

(Rep. Craig Thompson, a Harrisville Democrat, represents Cheshire District 14 in the New Hampshire House of Representatives.)


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