Disparities in access to dental care are all too real for many populations across the U.S. According to a report released in 2012 by the U.S. Senate Committee on Health, Education, Labor, and Pensions’ Subcommittee on Primary Health and Aging, more than 47 million people live in places where it is difficult to access dental care, 130 million don’t have dental insurance, about 17 million low-income children received no dental care, and over 830,000 visits to the ER across the country in 2009 were for preventable dental conditions resulting in health and economic consequences.
Pain is not the only consequence of lack of dental care. Untreated oral disease can lead to infections, tooth loss and has been shown to contribute to an increase risk of diabetes and heart disease. Moreover, low-income populations are disproportionally unable to access dental services, often opting to seek care—usually in the ER—when the problem is advanced and the pain unbearable. The ER visit is more costly than providing preventative dental care. For example, in Florida, 115,000 hospital ER visits in 2010 totaled more than $88 million in costs to Medicaid and other public programs.
The report recommended the expansion of dental coverage to adults on Medicaid and the integration of dental services into Federally Qualified Health Centers (FQHC or Community Health Centers) and School-Based Health Centers as a way of offering dental care to underserved populations. In fact some, FQHC’s, like Mary’s Center in Washington, DC are already providing dental services to their patients. Community Health Centers provide care to underserved populations in over 9,000 locations, 48 percent of which are rural, regardless of ability to pay.
However, states do place limits on the types or amount of services they will cover and can even elect not to provide dental coverage as a part of the Medicaid. An article from the March 2nd issue of the Bellingham Herald, Advocates: Restoring Preventative Dental Care for Poor Could Save Public Money, highlights the consequences of Washington State’s 2011 decision by the state to cut Medicaid payments for non-emergency dental care to balance the state budget. According to the article the cuts affected dental care for 450,000 adults on Medicaid. Even a local health center had to cut non-emergency dental care services to 5,500 of its Medicaid patients in the last year and a 2011Washington State Hospital Association study “found that among uninsured people those with dental problems were the most frequent visitors to the ER.“
Community Health Centers continue to expand their reach to care for millions and dental care is an important part of providing preventative health care services. In 2011 78 percent of FQHCs offered preventative dental care and provided over 3.1 million patients with oral dental exams. However, with the approaching cuts from the sequester and some states that refuse to offer dental coverage to Medicaid recipients or even take part in the Medicaid expansion, it remains to be seen if some FQHCs can continue and others can afford to provide dental services to their patients.