Virginia budget negotiators preserve adult Medicaid dental benefit

Virginia’s pared-down state spending plan retained one major priority for health advocates — a dental benefit for adult Medicaid patients.

General Assembly budget negotiators restored roughly $17.5 million in state funding to implement the coverage by July 1 next year. The two-year spending agreement, announced Wednesday afternoon, still has to go for a final vote before state legislators — and be signed by Gov. Ralph Northam, who can veto or request changes to specific spending items.

But safety net providers and advocates for low-income patients were optimistic that the dental benefit — “long overdue in Virginia,” according to Thomas Wilson, executive director of the Northern Virginia Dental Clinic — would pass after more than two decades of activism.

“When I got here 24 years ago, Virginia was one of only seven states that never had a dental benefit in its Medicaid system,” added Wilson, whose clinic serves adults in Northern Virginia with an income at or below 200 percent of the federal poverty level. “So, it’s about time we step up and provide that.”

Currently, the state offers comprehensive dental coverage to pregnant women and children until they reach the age of 20. But without an adult benefit, hundreds of thousands of Virginians are left with plans that cover nothing except emergency extractions.

Providers say the system creates huge problems for patients and for medical spending. Without preventive treatment, easily treatable problems, such as cavities, can spiral into major health concerns. Wilson said many of the patients seen at his clinic have received multiple extractions from years of poor oral health. Others have coexisting conditions, including diabetes, which can be exacerbated by dental issues. Gum disease, for example, can make it harder for the body to regulate blood sugar, and diabetes can also increase the risk of tooth infections and other oral health issues.

“That’s part of the problem — it becomes systemic,” Wilson added. Many medical groups have argued that the expanded benefit could help reduce overall health spending by improving chronic disease outcomes. 

A study by the Virginia Department of Medical Assistance Services, which administers the state’s Medicaid program, found that patients visited the emergency room roughly 19,000 times in 2018 for dental-related issues. Virginia Health Catalyst, an advocacy organization for oral health care, said the benefit could also reduce spending by preventing avoidable trips to the hospital. 

“I think we often talk about budgets reflecting values, and think the dental benefit is an example of that,” said CEO Sarah Bedard Holland. “There’s certainly more to do, but I think this is really important for advancing care in the commonwealth.”

Roughly 750,000 adult Medicaid patients would be eligible for dental services under the benefit, according to DMAS spokeswoman Christina Nuckols. It would cover preventive and diagnostic treatment, such as X-rays and exams, as well as oral surgery, root canals and prosthodontics, which includes items like dentures and bridges.

While it’s not mentioned in the budget amendment, Nuckols said the state would also leverage federal Medicaid funding to cover expanded dental services. For providers, safety net providers, the benefit could also be an important way to recoup the cost of care.

Wilson said his clinic charges patients a nominal $50 fee for services, but depends on grants and donations to reimburse the remainder of its operating costs. That’s become a challenge during the COVID-19 pandemic, as operating costs have risen exponentially and the clinic has been forced to dramatically reduce patient visits to less than half its normal volume.

If his board of directors decides to begin accepting Medicaid, it could be a way to help offset the cost of providing care, he added.

“It’s something for the board to decide,” Wilson said. “But do I think it’s a good opportunity? Yes.”