Coi Vanover, a retired coal miner, waits for free dental services in the early morning on July 22, 2017 in Wise. Hundreds of Appalachia residents waited through the night for the annual Remote Area Medical (RAM), clinic for dental, vision and medical services held at the Wise County Fairgrounds in western Virginia. The county is one of the poorest in the state, with high number of unemployed and underinsured residents. (Photo by John Moore/Getty Images)
By Steve Pollock and Sarah Bedard Holland
For adults who receive health care coverage under Virginia’s Medicaid program, access to oral health care was previously limited to emergency care only, which often meant care was only available when a person’s mouth was in such bad shape that tooth extraction was necessary, leaving a hole or holes in the mouth.
It certainly wasn’t a great way to manage dental care for already underserved people, and it was also bad economic policy. For many Medicaid-eligible adults, not being able to visit a dentist for routine, preventive care led to serious oral diseases, which frequently landed them in emergency departments across Virginia. In 2018 alone, this population accounted for 19,000 oral health-related emergency department visits. Because emergency departments are not equipped to treat dental issues, the patient frequently left without any treatment beyond temporary pain relief, and taxpayer dollars were wasted on a hospital visit where no real care was delivered. According to one study’s estimate, $1.7 billion is spent every year in the United States on emergency department visits for oral health issues.
Thankfully, both for the Virginians who will now have access to this care and for taxpayers, our leaders in state government recognized this and decided enough was enough. They worked collaboratively with advocates and with one another and passed this critical coverage into law and into the state budget. It’s something we are certainly grateful for and everyone involved should be proud.
But while expanding coverage is a necessary and excellent first step, it only creates theoretical access to care if we don’t do the hard work to make it a reality. To truly create care opportunities for adults covered by Medicaid, we need more dentists to enroll as Medicaid providers. More than 1,900 dentists are signed up and we are confident more will join them.
Because, as these dentists know, the impact of their care isn’t limited to a patient’s mouth. Oral health care is health care, and we’ve long known the critical connection between the mouth and one’s overall health. This state policy change is recognition of that importance.
Years of research has shown that poor oral health has a direct link to higher risks of chronic illnesses, including diabetes, cardiovascular disease, hypertension, asthma and more. It also increases risk of suffering a stroke and leads to greater instances of depression and other mental health illnesses.
One recent study found a link between better preventive oral health and a reduced risk of ventilator-associated pneumonia (VAP). VAP is a leading cause of death among critically ill patients and has posed a serious problem for those afflicted with COVID-19 who require mechanical ventilation. According to the report, having at least one preventive dental visit within three years of being placed on a mechanical ventilator reduced a patient’s likelihood of a VAP diagnosis by 22 percent.
Being able to access oral health care isn’t just going to improve physical health outcomes for many of our friends and neighbors. It will also assist with employability, improve mental health and enable health systems to provide more equitable integrated care to Medicaid members.
With this expansion of coverage, adults on Medicaid will now be able to visit the dentist for routine care three times each year. With the help of dentists across the commonwealth, and the state’s efforts, we know that the capacity will exist for all of these newly eligible patients to be able to access the care they need.
Every dentist who signs up to treat Medicaid patients will be improving the health of hundreds of thousands of Virginians. They will also be breaking down the deep disparities in care that have existed for generations.
Put simply, this new law is a potential game-changer for a population that is too frequently left behind by our health care policies. Now, it’s up to us to make it a reality.
Steve Pollock is president and CEO of DentaQuest, the organization that administers the Medicaid dental benefit in Virginia. Sarah Bedard Holland is CEO of Virginia Health Catalyst.
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