Before Virginia’s new Medicaid benefit took effect last week, the only dental care the government insurance covered for adults was pulling teeth.
People often suffered so long, they ended up in hospital emergency rooms with severe infections that went well beyond abscessed teeth, said officials with the Virginia Department of Medical Assistance Services. Also known as DMAS, it’s the state agency that administers Medicaid, which is a state and federal program.
Or, people went to clinics offering free dental services and had a lifetime of decay removed in one sitting, said Dan Plain, division director of health care services at DMAS.
“It was heartbreaking that all adults could get were extractions,” Plain said, noting that, “It was really common for people to get multiple extractions, 10 or 11 at a time. That’s devastating physical and mentally. Now we can work to stop this.”
The new coverage for adults began July 1 and includes up to three regular cleanings a year along with preventive care, X-rays, fillings, dentures and oral surgeries. Gov. Ralph Northam called it an “historic expansion” and celebrated, along with other health officials, the news that more than 750,000 adults in Virginia have access to comprehensive dental services.
“The new adult Medicaid benefit is an important step for connecting underserved Virginians with critical preventative, restorative and surgical dental care,” said Dr. Frank Iuorno Jr., president of the Virginia Dental Association. “Expanding access to oral health care is important for all Virginians. No person should have to go weeks or months in pain waiting for treatment.”
While local clinics and dental officials also see the change as good news, they wonder how many area dentists will accept Medicaid, which reimburses far less than private insurance. The state offers comprehensive dental coverage to children under 20 and pregnant women, and about one-third of dentists statewide have accepted Medicaid payments in the past, Plain said.
State officials have been working to recruit more with the rollout of the adult benefit. As of last week, 73 providers in Fredericksburg and the counties of Caroline, Spotsylvania and Stafford signed up to accept adult Medicaid patients, said Cheryl Roberts, deputy of programs and operations at DMAS.
The agency worked with DentaQuest, the state’s Medicaid dental benefits administrator, which interviewed each local provider who “had to affirm they are willing to take adult patients and had openings,” Roberts said. “I’m pleased you have a good number of dentists in your area.”
The number seems high, said Karen Dulaney, executive director of the Moss Free Clinic, which is always looking for doctors and dentists willing to help with their cases.
“Are they technically Medicaid providers but they aren’t accepting Medicaid patients? We’ve seen that in the past,” she said. “Traditionally, Medicaid reimbursement for the health care system has not been good.”
Dr. Justin Edwards knows all about that. The Fredericksburg dentist focuses on pediatric patients and sees a number of Medicaid clients because he feels like it’s his duty to help the less fortunate.
But for every $100 he bills, Medicaid only pays $20 to $30, and his practice has to eat the rest. Not everyone who leaves dental school—with bills as high as $300,000—can operate that way, Edwards said.
Whatever reimbursement Medicaid provides for dental care will be more than the Moss Free Clinic has received in the past, Dulaney said. For more than 25 years, the clinic has provided free dental and medical services to low-income, uninsured and underserved adults in the Fredericksburg region—and relied on grants, donations and services provided by volunteers to keep the doors open.
“Dental care is certainly a need in this population,” Dulaney said. “They’ve never had access to routine dental care, and they wait until it’s so bad, it impacts their overall health.”
With the expanded coverage, the Moss Free Clinic also will need more volunteers to treat dental patients, she said.
Staffing also is an issue at two nonprofit community health centers that operate in the region. Central Virginia Health Services, or CVHS, has offices in Fredericksburg and Bowling Green for people with limited access to health care. Co-pays are based on income and are as low as $5, said Lisa Hernandez, practice manager in Fredericksburg.
She expects the new Medicaid benefit to increase the demand for the center’s dental services. The problem is: “Our particular site is extremely shorthanded, so we’re not able to get a lot of patients in. That’s something we’re working on.”
In the past, the center has tried to compile a list of other providers who accept Medicaid, “but they’re really hard to find,” she said, adding that the center often has to send patients to the VCU Medical Center in Richmond.
Like state officials, Hernandez agreed that the dental coverage for adults with Medicaid is a big deal because it provides so many more options. And the timing couldn’t be better. Recent surveys by the Health Policy Institute illustrate the impact the global pandemic—and the stress it’s brought on—has had on oral health.
More than 70 percent of dentists surveyed nationwide saw more patients experiencing teeth grinding and clenching, conditions often associated with stress. More than 60 percent of dentists reported an increase in other stress-related dental conditions, including chipped and cracked teeth, headaches and jaw pain.
Other studies in recent years have shown that “the mouth is a gateway to the body,” Edwards said, and that a person’s dental health impacts what’s happening in the rest of the body. Research has linked poor oral health with high blood pressure and cardiovascular problems as well as pregnancy and birth complications.
Then there’s the issue of a person’s self-esteem and even the ability to find a job, Roberts said.
“People tend not to get hired if they don’t have good teeth,” she said. “They’re stigmatized.”
She said hopes the new Medicaid benefit will “be life-changing” on many different levels.
Cathy Dyson: 540/374-5425