900 Oral health care provider viewpoints inform latest NCD recommendations on Medicaid, Medicare

Wednesday, April 5, 2023

FOR IMMEDIATE RELEASE

April 5, 2023

WASHINGTON—Today the National Council on Disability releases its second report focused on addressing unmet oral health care needs of people with intellectual and developmental disabilities (I/DD) with compelling data from over 900 providers.

Incentivizing Oral Health Care Providers to Treat Patients with Intellectual and Developmental Disabilities provides additional insights into sources and solutions regarding the difficulties of adults with I/DD in accessing quality, appropriate, and timely oral health care (OHC) services. Last year, NCD published Medicaid Oral Health Coverage for Adults with Intellectual & Developmental Disabilities – A Fiscal Analysis, providing the initial results of its analysis into how to improve oral health outcomes for people with I/DD.

In 2022, on behalf of NCD, the Medicaid

Medicare

CHIP Services Dental Association, in collaboration with the American Academy of Developmental Medicine and Dentistry (AADMD) and the Special Care Dentistry Association, undertook a study of OHC providers across the United States to explore the factors and policy incentives that influence their decisions to treat (or not) individuals with I/DD and to participate (or not) in government programs that provide coverage for dental care for individuals with I/DD.

“Having such an extensive dataset of providers who have participated in and are familiar with Medicaid was critical to ensure our recommendations to policymakers were valid and achievable,” said NCD Chairman Andrés J. Gallegos. “Achieving health is a predicate to achieving so many disability policy goals; and oral health is a predicate to one’s overall health in many instances, making the focus of this report critically important.”

The report examines legislative, environmental, and system factors as key to expanding access to OHC services for adults with I/DD.

Key findings include:

Medicare and Medicaid programs do not support dental care for adults with I/DD.
Unlike the Medicaid medical program, Medicaid dental programs do not capture or link dental services to medical necessity.
State Medicaid programs are not required under federal law to cover dental services for adults with I/DD. Existing Medicaid programs serving people with I/DD generally exclude dental services.
Dental and medical systems of health care do not support integrated health care models for people with I/DD.
Few professional dental education and continuing education programs incorporate integrated health care models.

“People with I/DD remain the largest minority population with unmet oral healthcare needs,” said Council Member Shawn Kennemer. “To achieve health equality for people with I/DD, policymakers need to examine the shortcomings of current policy against the backdrop of national goals for people with disabilities. As Chairman Gallegos often says, ‘Health is the predicate to living, learning, and earning’ alongside nondisabled peers. NCD’s latest analysis is intended to assist policymakers in taking critical next steps.”

The report contains key recommendations for Congress, the U.S. Department of Health and Human Services, including the Centers for Medicare and Medicaid Services; professional associations and dental schools; and dental professionals. NCD’s recommendations provide the framework for systems change and redesign, including a new government program in Medicare that supports better care at a lower cost for an aging population of adults with I/DD living in noninstitutionalized settings across all states.

NCD is an independent federal agency that advises the President, Congress and other federal agencies on disability policy.

NCD has worked on OHC issues and includes it in our 2022 Health Equity Framework. In 2017, NCD published Neglected for Too Long: Dental Care for People with Intellectual and Developmental Disabilities, and in 2019 made recommendations leading to a change in policy requiring all U.S. dental schools to train students to manage treatment of people with intellectual, developmental disabilities.

The report is available at NCD.gov.