Dental Medicaid for Adults. Shouldn't Meidicaid Dental be available for Adults as well as Children?

Shouldn't Medicaid Dental be available to adults as well as children?

There is a proven link between bad teeth and bad health. For many in the lower socio-economic sections, lower income people cannot afford a basic visit to a dentist. So they will wait until the agony of an abscess will drive them to a clinic where the most cost effective , read cheap, remedy is extraction.

Bad teeth affects all aspects of a persons health. Not fixing one's teeth has a domino effect on the health care system. To leave the mouth out of the health equation is to ignore the part that it plays in the health of the entire body. People with severe dental problems find it difficult to eat. Pain in the mouth is just as debilitating as pain anywhere else, if not worse.

Managing population health is about prevention. Ensuring that everyone gets access to a checkup once a year will do a lot to reduce dental problems and guarantee that when they do present, they are at the cheap and simple end of the treatment spectrum.

According to the Federal Government, Dental services under Title XIX of the Social Security Act, the Medicaid program, are an optional service for the adult population, individuals age 21 and older. However, dental services are a required service for most Medicaid-eligible individuals under the age of 21, as a required component of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.

Individuals under Age 21

EPSDT is Medicaid's comprehensive child health program. The programs' focus is on prevention, early diagnosis and treatment of medical conditions. EPSDT is a mandatory service required to be provided under a state's Medicaid program.

Dental services must be provided at intervals that meet reasonable standards of dental practice, as determined by the state after consultation with recognized dental organizations involved in child health, and at such other intervals, as indicated by medical necessity, to determine the existence of a suspected illness or condition. Services must include at a minimum, relief of pain and infections, restoration of teeth and maintenance of dental health. Dental services may not be limited to emergency services for EPSDT recipients.

Oral screening may be part of a physical exam, but does not substitute for a dental examination performed by a dentist as a result of a direct referral to a dentist. A direct dental referral is required for every child in accordance with the periodicity schedule set by the state. The Centers for Medicare & Medicaid Services does not further define what specific dental services must be provided, however, EPSDT requires that all services coverable under the Medicaid program must be provided to EPSDT recipients if determined to be medically necessary. Under the Medicaid program, the state determines medical necessity.

If a condition requiring treatment is discovered during a screening, the state must provide the necessary services to treat that condition, whether or not such services are included in the state's Medicaid plan.

Individual age 21 and older

States may elect to provide dental services to their adult Medicaid-eligible population or elect not to provide dental services at all as part of its Medicaid program. While most states provide at least emergency dental services for adults, less than half of the states provide comprehensive dental care. There are no minimum requirements for adult dental coverage.

The American Dental Association has this to say:
Medicaid is the nation’s largest publicly funded health insurance program. It is the primary source of health care for 28 million low-income children and provides coverage to millions of additional low-income families, the elderly and the disabled. Medicaid is jointly financed by the states and the federal government and is administered by the states. Federal law requires that states offer a set of mandatory benefits and provide coverage for certain populations.

Dental services for children enrolled in Medicaid are regulated through the Early and Periodic Screening, Diagnosis and Treatment program (EPSDT). However, states are not required to provide dental services to adults. Unfortunately, access to dental benefits is limited as a result of benefit designs and low reimbursement rates to dentists.

Payment rates for Medicaid dental services typically fall well below the cost of providing treatment. Poor financing ultimately leads to patients’ inability to access oral health care services, which only intensifies the severity of their need for help. Improving financing and program administration will improve access for Medicaid beneficiaries who need assistance.

ADA Priorities

* The ADA urges the Congress to maintain the federal requirement for dental  services under EPSDT and extend medically necessary services to Medicaid-eligible adults.
* The ADA urges the Congress to preserve the federal financing role in the Medicaid program and update the federal matching formula to address economic changes.
* The ADA believes preventive dental services should be exempt from cost-sharing requirements.

What does this mean for you?

Medicare generally does not cover dental care services. It does, however, cover hospitalization for non-covered dental services when the severity of the procedure or the condition warrants it. On the other hand, Medicaid, which is a public assistance program financed by federal, state, and local governments, offers more preventive-care services. Each state designs its own plan according to federal guidelines. Low-income people who fit into the following categories receive Medicaid coverage: the aged (sixty-five years or older), the blind, the disabled, members of families with dependent children, and some other children. Some states provide coverage for other groups of low-income people who, although qualified for welfare, aren’t able to afford medical care.

Because each state designs its Medicaid program to meet the needs of its own residents, and because Medicaid is subject to funding problems, states that might have covered a benefit at one period of time may no longer do so. Consequently, it’s prudent to ask your state or county department of public welfare whether the Medicaid program in your state covers dental care services, for children as well as for adults over the age of twenty-one. Dental care under the Medicaid program is an optional service for the adult population, which includes individuals twenty-one years of age and older. However, dental services are a requirement for most Medicaid-eligible individuals under age twenty-one, as a mandatory component of the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit. States may elect to provide dental care services to their adult Medicaid-eligible population, or elect not to provide dental services at all as a part of their Medicaid program. Most states provide at least emergency dental services for adults, but less than half of all states provide comprehensive dental care. There are no minimum requirements for adult dental coverage.

People with low incomes have the least access to dental care, and dental care has been a particular concern in many state Medicaid programs where the utilization of dental services by beneficiaries has been low. This lack of utilization among Medicaid beneficiaries is due to two major factors: a lack of dentists willing to serve Medicaid beneficiaries and the low priority many Medicaid families may place on obtaining dental care (low-income families have many competing needs, are often unaware of the importance of oral health care, and may be unwilling or unable to wait for appointments or arrange transportation to a dental appointment).

 

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41 records found. Showing page 1 of 3.

DATE: 6/19/2017 12:33:06 AM ... SCREEN NAME: breenon77
I'm 62 disabled just got it this year but I'm barely making it from month to month my teeth are falling out please help
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DATE: 12/9/2016 9:36:23 PM ... SCREEN NAME: Cinnamon45
I'm 52 years old and I'm disabled with a lot of health issues that make me very sick most of the time. I'm a diabetic high blood pressure thyroid disease osteoarthritis, osteoporosis, degenerative disc disease and heart disease. My gums are infected, two bad cavities and no back teeth at all. I'm going to die if I can't get help getting my mouth fixed. Why want y'all help us.
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DATE: 11/14/2016 3:35:41 PM ... SCREEN NAME: Martin
I am one the people asking for help with my teeth.I am also in pain with bad teeth can we get help
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DATE: 8/13/2016 6:38:57 AM ... SCREEN NAME: Charles
I am 46 year old and disabled all my teeth are braking at the gum and causing pain and cant afford to have them fixed is there any help for me.
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DATE: 3/13/2016 11:14:37 AM ... SCREEN NAME: Michelle in tn
I'm 53 disabled live alone on SS AND SSI and barely make it month to month. Have gum duease and very few teeth left which are rotten missing two in front and ashMed to be in public. Have a lot of canker sores or ulcers and slit if pain Use warm salt warter daily and cry from toothpaste food etc burning my mouth. My only daughter is getting married in May and I ashamed to be there. Michelke
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DATE: 11/7/2015 3:33:32 AM ... SCREEN NAME: Sheena sutterfield
My teeth are all broke off to the gum line and I can taste infection all the time please help
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DATE: 10/10/2015 12:58:23 PM ... SCREEN NAME: Meme
Avendo lavorato pserso uno studio dentistico mi e8 rimasta un po' di deformazione professionale e quindi guardo la bocca a chiunque e spesso rabbrividisco ..Bisogna curare bene la bocca perche8 e8 importantissimo, glielo dico sempre a Riccardino, il quale, devo ammettere che e8 proprio bravo (come Stellina e Sebastian).Complimenti a Catharina per il suo piccolino: e8 bellissimo!!!!!Buona serataIvana
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DATE: 8/15/2013 5:46:18 PM ... SCREEN NAME: Becca S
I am 26 years old and lost my fillings after having my first child. I was not told about the effects that child birth has on your teeth, and lost all of my fillings in the front top teeth in my mouth. Trying to find a dentist was a nightmare and extremely costly, so being a low income family and just having a new baby in the home, I could not have them fixed. More of my teeth have broken and weakened, and I'm frightened to eat certain items because I feel that one could break any moment. I have lost pieces while brushing, as well. My entire atmosphere change because I was once social and happy and now I can barely introduce myself because of the embarrassment of a person staring into my mouth as I speak. I do not smile nor do I talk loud enough for some people to hear me. I recently went to a dentist who told me that they would have to charge almost $17,000 to be able to complete everything I needed done. I have no dental insurance and do not even know how to go about getting the right one. I will graduate college in a few months and have had nothing but a hard time trying to get a decent job because of my teeth. People seem to treat you differently and look at you differently when your teeth have been destroyed as mine have. I want to be able to smile for my graduation pictures but attempting to come up with $3000 a month is ridiculous! Being so young, it is an extreme disappointment to have a smile like mine, and an even bigger one trying to find out how to pay to fix it! I cannot get a credit line either. I'm out of options except to try and pay the lump sum or deal with the pain and embarrassment of my far from perfect teeth...
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DATE: 5/16/2013 4:21:06 PM ... SCREEN NAME: MADMKL
MY STRY IS ALMOST EXACTLY LIKE LINNIELOU'S AND I FEEL FOR HER I AM A 41 YR OLDMALE WITH THE SAME PROBLEMS AND THOUGHT I WAS ALONE,PLEASE HELP US AND MAY GOD GIVE EACH AND EVERYONE OF UG ALL THE STRENGTH IT TAKES TO HOLD ON TILL WE CAN FIND HELP.THANK YOU
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DATE: 5/6/2013 6:59:58 AM ... SCREEN NAME: cheryl171@live.com
If my medicaid did pay for dental I would need to find a denist who would execpt it.
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DATE: 4/23/2013 2:10:29 PM ... SCREEN NAME: lynnielou
Hello,
My name is Ellen Rice I am a 45 year old Caucasian female. I am writing to you desperate for help. Five years ago I was hospitalized with Liver Failure. The medications I was prescribed, by doctors, over the past four years have made my teeth rot, break off and fall out. At this time I have only eight teeth left in my mouth, four of which are only roots that are always infected and causing dangerous abscesses or cysts. Over the course of time I have been to 11 different dentists only to be turned away as I have another condition in my mouth that causes boney growths called Torro`s. I am currently taking stronger then normal antibiotics as the more common antibiotics are no longer affective on these infections that are ravaging in my mouth.
I have over the course of time become severally depressed. I can not eat or sleep and have basically become a hermit ,a prisoner of shame and despair. I recently thought I had this all worked out with an oral surgeon. However the private insurance I was able to acquire, pays only a portion of the entire amount. Due to the fact that I am low income and my credit score is not as good as it could be, they refused to finance the co pay I am responsible for in the amount of 3500.00 dollars. I have the worksheet from this doctor and sadly after all of this is completed, all the pain and suffering of this devastating period, I still will not have any teeth in my mouth. Leaving me still unable to eat or smile or feel less ashamed, however I would be able to heal and not be knocking at death’s door. I am a mother of three and grandmother of two and would like nothing more then to be able to care for my family and become contributing member of society again. I also have a fiancé` whom I would love to stand up and marry….but I would like to be able to smile at him and not be so totally ashamed. Four years ago I had a mouth of perfect teeth, and now here I am on the brink of death.
I am so scared that one of the infections to come will be resistant to the antibiotics there will then be nothing anyone can do. I am not ready to die, so please I beg of your help .I still have a family who very much still needs me, and I don’t want to leave them…I cant imagine leaving them!
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DATE: 4/11/2013 9:18:48 PM ... SCREEN NAME: mommyangel78
hi my name is Kelly and live in Illinois and only have the medical card for insurance and need all my teeth extracted and need dentures but can not afford them my teeth are actually s bad that it makes me sick and is actually interfering with my work and family life is there any suggestions or services that you can suggest or do?
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DATE: 2/7/2013 11:30:45 AM ... SCREEN NAME: r0xurw0rld2012
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DATE: 1/23/2013 8:53:29 PM ... SCREEN NAME: mando
sant din bucuresti.
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DATE: 1/23/2013 8:51:55 PM ... SCREEN NAME: mando
am 36 de ani si am probleme foarte mari cu dantura. daca exista vre.o clinica stomatologica care face interventi gratuite va rog sa.mi spuneti. multumesc
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