Investments Needed in a Critical but Sometimes Overlooked Component of Healthcare – Oral Health


The governor’s budget for the year starting Oct. 1, 2015 includes significant investments for both children and adults in a critical, but sometimes considered optional, component of healthcare – oral health.

The Problem

Oral health impacts every aspect of an individual’s life, from the young to the elderly, from how one feels, to how one looks, to how one is able to eat or not, to how one is able to concentrate at school or at work. Oral health disease is very costly when it forces individuals to hospital emergency rooms where the only treatment is for the pain and not the problem. Even more tragic are hospital admissions to intensive care units when untreated dental infections travel to other parts of the body, such as the heart. Dental disease has been linked to chronic diseases such diabetes, stroke and heart disease. In addition, research is linking poor maternal oral health to preterm and low-birthweight babies.

Tooth decay remains the No. 1 chronic disease in children, but it is preventable with access to good dental care. Like potholes, cavities just grow larger, more expensive to repair and more painful. All children need to be able to learn and progress in school, but toothaches and other dental problems cause them to lose concentration or miss school.

It is critical that all Medicaid-eligible children in Michigan have access to the Healthy Kids Dental program and to good oral health opportunities.

A Partial Solution for Children and Adults

The governor recommends continuing expansion of the Healthy Kids Dental program but not to all Medicaid-eligible children. His recommendation is to expand the program into the three remaining counties without the program (Kent, Oakland and Wayne) but only to children under age 9. While continued expansion is very good, it does leave more than 170,000 low-income children without coverage, many of whom are children of color. The recommendation calls for investing $22 million, including $7.5 million in state funds. These children and their families have waited a long time for this coverage – essential for children to be healthy and able to learn. Tooth decay has been shown to impede academic progress as well as social progress.

Another key investment in the governor’s budget is $12 million, including $8 million in state funds, to expand access for adult dental services for Medicaid enrollees by implementing a statewide dental managed care contract and eliminating the current ineffective fee-for-service system. This proposal, if adopted, will be implemented in the last quarter (July – September) of budget year 2016. While Medicaid currently covers dental services for adults, few dentists participate due to the extremely low reimbursement rates. Poor access can result in escalated health conditions for adult Medicaid enrollees that drive individuals to seek care in hospital emergency rooms and sometimes inpatient stays if the dental infection travels to other parts of the body (i.e., the heart). In addition, treatment in the emergency room does not treat the underlying dental condition. Rather, individuals are simply given pain medication, perhaps antibiotics, are told to follow-up with a dentist, and are sent home.

Legislative Action to Date on the Governor’s Proposal

The House subcommittee concurred with the governor’s recommendation to expand Healthy Kids Dental to children 0-8 in Kent, Oakland and Wayne Counties. The subcommittee did not concur with the recommendation to expand access to adult dental services indicating further discussion is needed.

The Senate subcommittee concurred with expanding Healthy Kids Dental to the three remaining counties, but delayed implementation until July 1, 2016 in order to cover all eligible children in those counties, not just children under age 9. The subcommittee concurred with the governor’s recommended managed care contract for Medicaid adult dental services but recommended implementation be delayed from the governor’s recommended July 1, 2016 until September 1, 2016.

Comprehensive Solution for Children and Adults

To fully address the oral health needs of Medicaid enrollees, both children and adults, expanded access to preventive and treatment services is needed. Full expansion of Healthy Kids Dental to all Medicaid-eligible children in all counties is essential. Expanded access for adult Medicaid enrollees also is imperative to allow routine, preventive services as well as treatment to be provided at the right time, by the right provider and in the right setting. Most dental conditions can and should be treated in dental offices, not in hospital emergency rooms.