For the past 10 years, Maryland’s health care system and agencies such as the National Institutes of Health and Johns Hopkins University have ranked the state as one of the best in the nation.
But there’s been one glaring omission: dental coverage for adults, specifically for residents who make 133% of the federal poverty level or less but aren’t able to receive basic oral health care.
This year’s poverty level, according to the American Council on Aging, sets the income level at $1,506 monthly per person. The amount increases by $523 per additional household member, capped at $5,168 for a household of eight.
Sen. Malcolm Augustine (D-District 47) of Cheverly said Maryland is one of three states, along with Alabama and Tennessee, that doesn’t mandate dental benefits for about 800,000 Marylanders on Medicaid.
In that vein, Augustine and fellow Sen. Guy Guzzone (D-Howard County) are co-sponsoring legislation for a pilot program to provide certain dental coverage.
“From a policy perspective, there is no dispute that providing comprehensive dental coverage will improve overall health outcomes and all aspects of [an] individual’s health,” Augustine said during a virtual public hearing Tuesday before the Senate Finance Committee. “There is a significant fiscal note, but I want to make sure that we place this in the context that we invest $14 billion annually in our Medicaid population.”
A financial analysis shows it could cost an additional $82 million in fiscal 2023 and $166 million in fiscal 2024. However, the federal government would cover 60%, with the remaining 40% picked up by the state.
Augustine said future financial savings would enable residents to not only receive regular health checkups, but also reduce emergency room visits and chronic diseases.
“This situation does not reflect our state’s values, nor does it reflect our priorities,” he said.
Sen. Ben Cardin (D-Maryland), who testified Tuesday, mentioned Deamonte Driver, a 12-year-old boy from Prince George’s County who died in 2007 of a brain infection stemming from an abscessed tooth.
Cardin stressed that a routine $80 tooth extraction would’ve saved Deamonte’s life, but his mother couldn’t find a dentist to treat him because of the state’s limited Medicaid dental care program during that time.
Today, all children are provided dental coverage.
In 2019, the state health department established a “Healthy Smiles” dental program for adults ages 21 to 64 years who receive both full Medicaid and Medicare benefits.
The policy note summarizes other ways adults under Medicaid receive dental coverage: pregnant women with incomes up to 250% of the federal poverty level, certain foster care adolescents, adults who qualify through the state’s Rare and Expensive Management (REM) program and other Medicaid programs that voluntarily cover limited dental services.
Other than that, only emergency dental services are provided for adults.
“It’s also a matter of equity in our community,” Cardin said. “When we look at those who have untreated dental disease among the adults, it is two to three higher numbers in communities of color. This is a matter of justice. It’s a matter of cost. It’s a matter of doing what’s right [and] continuing Maryland’s leadership.”
More than two dozen doctors, nurses and health care advocates also spoke Tuesday in support of legislation.
Dr. Melani Bell, vice president of the Maryland Nurses Association, said adequate dental coverage should be kept up at a minimum of every six months. She also said it lowers health care costs for people diagnosed with diabetes or cerebrovascular and coronary artery diseases.
“If one doesn’t have access to routine cleanings and examinations, [that person is] vulnerable to diseases which can affect the brain, cardiovascular and gastrointestinal systems,” Bell said. “Adding dental coverage provides additional tools to keep people healthy and thriving.”