Although five Medicaid programs--California, Colorado, Illinois, South Carolina and Washington--started offering dental coverage to their members last year, most consumers still struggle to find dentists willing to treat them because of Medicaid's typically low provider reimbursements, reported Kaiser Health News.
Medicaid usually only reimburses dentists about 50 percent as much as private insurers pay. For example, Colorado's Medicaid program pays dentists $87 for a tooth filling and $435 for a crown, compared to $150 and $800, respectfully, that private insurance reimburses.
Without access to dental care, many Medicaid members eventually go to emergency rooms, which can predominately only offer short-term pain relief, or go without care, which can lead to more serious and costly health problems such as heart disease, diabetes and rheumatoid arthritis.
"Translating Medicaid coverage into care is a significant problem," David Jordan, who directs the dental access project at Community Catalyst, a national consumer advocacy group based in Boston, told KHN. "The number of adults on Medicaid who are able to see a dentist is woefully short of where it needs to be."
Indeed, a study from nonpartisan Colorado Health Institute found that "getting oral healthcare is difficult, if not impossible, for many of Colorado's Medicaid clients." According to the study, the number of Colorado consumers, including children, who are eligible for Medicaid dental coverage tripled to almost 1 million, but the number of dentists willing to treat Medicaid patients increased by just 17 percent.
In Washington state, meanwhile, just 15 percent of adult Medicaid enrollees received dental care last year, even after that state expanded dental coverage, Christina Peters, of the Washington Children's Health Alliance, told KHN.
The problem extends beyond Medicaid. Although the Affordable Care Act requires plans sold on exchanges to include dental coverage, it's only optional for children, FierceHealthPayer previously reported. This could leave as many as 3 million children without dental insurance by 2018.