Medicaid Adult Dental Waiver Program
Too many Maryland adults face serious financial obstacles to obtaining dental care. Maryland is just one of 16 states without dental coverage for adults in the Medicaid program. Over two-thirds of states provide some kind of basic adult dental benefits. Maryland only provides adult dental coverage for narrow eligibility categories, such as pregnant women and young adults who have aged out of foster care. Although dental professionals statewide strive to help at-need patients through programs and non-profits that offer low-cost care, the more than 2,500 free adult dental procedures performed annually at Dental Mission of Mercy events in Maryland clearly demonstrate a growing oral health crisis and the need for affordable dental care.
The inability to access routine dental care drives many Maryland adults to the emergency room with tooth pain and oral infections. Emergency rooms are unable to treat the causes of dental pain, so they treat the symptoms and send patients home with antibiotics, pain medications, or referrals for dental services that patients may not be able to afford. Maryland taxpayers pay for the high cost of the emergency room visits to relieve the pain without treating the dental condition. This is a poor use of resources and is terribly ineffective.
Through the Maryland General Assembly’s unanimous support of Senate Bill 169, MDAC studied the cost of emergency room visits for adults with chronic dental conditions. The legislation was the result of the leadership of Senators Thomas M. "Mac" Middleton and Ed Kasemeyer and Delegate Mike McKay.
In fiscal year 2016, Maryland adults made 42,327 emergency department visits for chronic dental conditions, with an average charge of $537 per visit, for a total of $22.7 million. These visits represent almost 2% of overall emergency room costs. Medicaid paid for 53% of those visits, even though Medicaid participants only account for 15% of the adult population in Maryland. This discrepancy is likely the result of the lack of consistent adult dental coverage in the Medicaid program.
In 2018, the Maryland General Assembly unanimously passed SB 284 –Maryland Medical Assistance Program – Dental Coverage for Adults – Pilot Program, legislation that established a waiver program to cover adult dental services in Medicaid. MDAC strongly supported the bill. Senators Thomas Middleton, Guy Guzzone, and Delegate Mike McKay were proponents of the legislation, an important step forward in demonstrating that a Medicaid adult dental benefit that enables adults to establish a dental home, obtain preventive care, and avert costly dental conditions is a good investment in health outcomes and the fiscal health of Medicaid.