Medicaid Oral Health Coverage for Adults with Intellectual & Developmental Disabilities – A Fiscal Analysis

SCOPE AND PURPOSE: In its preliminary research into how to improve the oral health of people with intellectual and developmental disabilities (I/DD), NCD examined:

• The relationship between states’ Medicaid dental benefits and the receipt of basic dental care among adults with I/DD;
• The relationship between state waiver programs and receipt of dental care;
• The estimated cost and potential savings of implementing basic dental Medicaid benefits in states that do not currently offer it;
• The role of coordination between developmental disability (DD) agencies and Medicaid agencies for improving access to dental care; and
• Promising Medicaid-funded state and private strategies for expanding dental care for adults with I/DD.

NCD’s ongoing policy focus on health equity led NCD to pursue an examination of the dental care experiences specific to individuals with I/DD under Medicaid. This initial report is part of ongoing related research into how to incentivize oral health providers to participate in Medicaid. A future study will examine why providers choose not to participate in Medicaid programs and waivers that facilitate the treatment of patients with I/DD and the potential incentives that could rectify that problem.

KEY FINDINGS: Of the nearly 7.3 million adults with I/DD in America, nearly 4.5 million rely on Medicaid for health coverage. NCD found that Medicaid does not uniformly provide adults with I/DD dental coverage and twelve states do not provide basic dental benefits aside from limited waiver programs in seven of them. This often times results in adults with I/DD in those states foregoing preventative and routine dental care and seeking emergency dental care at much higher cost, and/or developing chronic health conditions. Existing research shows dental health is the predicate for general health and general health is the predicate for positive employment, education, and community living outcome, yet adults with I/DD ages eighteen years and older experience poorer oral health and significant barriers to obtaining oral health care, relative to adults without I/DD. Poor oral health not only often leads to chronic disease, it also increases the likelihood of experiencing poor physical health.

NCD’s study estimates federal and state governments combined would realize a ROI of approximately $7.7 million beyond recovering the initial cost, annually, and the share of that ROI for those twelve states would total close to $3 million, annually. NCD estimates an overall modest return on investment for providing basic dental coverage for adults with I/DD in those states that provide emergency-only or no coverage ranging from an increased cost of $60,358 in Nevada to as much savings as $829,803 in Maryland – with costs likely offset by eliminating costly trips to the emergency room.

KEY RECOMMENDATIONS:

• States should add dental benefits for adults with I/DD to their 1915(c) and 1915(i) waivers or 1115 demonstrations and refer to those states that currently extend dental coverage to adults with I/DD as a model. States should consider available data about and evaluations of these waiver programs to prioritize the types of dental services and target populations to include in their own waivers. States can use available data as guidance to maximize access to key, cost-effective dental services while balancing available funding.
• States should fund programs that address the additional barriers to obtaining oral health care through Medicaid, including incentivizing the dental workforce to attract providers with expertise in treating adults with I/DD through continuing education programs, implementing programs that improve daily oral care provided by caregivers, and improving education and support for good oral hygiene for adults with I/DD. Additionally, states should address transportation barriers and coordinate services between DD agencies and Medicaid providers.
• The U.S. Department of Health and Human Services, through the Administration on Community Living, should conduct additional research to offer policy insights and recommendations that would reduce the need for the receipt of dental care in the OR and to improve access to the OR for people with I/DD.

RELATED NCD REPORTS AND PUBLICATIONS:

• Medicaid Oral Health Policy Database (XML)
• Health Equity Framework (2022)
• Vision and Priority Statement of Chairman Gallegos (2021)
• At NCD’s recommendation, all U.S. dental schools will train students to manage treatment of people with intellectual, developmental disabilities (2019)
• Neglected for Too Long: Dental Care for People with Intellectual and Developmental Disabilities (2017)
• The Current State of Health Care for People with Disabilities (2009)