How Dental Coverage Falls Short For Low-Income Americans

Four-year-old Torrie Smith, a little girl in a low-income Colorado household, suffers from devastating dental health issues. Her plight could have been avoided with regular preventative dentist check ups, which would have been free for Torrie under Medicaid — but her mother Wendie didn’t know about the dental health benefits afforded to Torrie under the public insurance program until it was far too late.

Torrie’s issues underscore the considerable gaps in America’s dental health coverage system. Dental insurance remains elusive even for many who have employer-sponsored health coverage — some estimates peg the number of Americans forgoing dental care at over 100 million, with children and the poor being disproportionately affected. That’s particularly bad news considering that dental problems are lifelong problems, and poor dental health early on in life leads to a status quo in which over a quarter of elderly Americans over the age of 65 lose all of their teeth.

And as the Coloradoan reports, even Medicaid beneficiaries face a dearth of coverage due to low reimbursement rates for dentists accepting Medicaid patients:

State Medicaid data reported to the federal government show that less than half of the 453,000 Coloradans under age 21 who were eligible for benefits in federal fiscal year 2011 received some kind of dental service. Only a quarter of Colorado counties met a 2010 state goal of getting at least 44 percent of Medicaid-eligible residents under age 19 to visit a dentist, according to an I-News analysis of state records.

“Dental disease is not self-resolving,” says Diane Brunson, director of public health for the University of Colorado’s School of Dental Medicine. “It’s not like catching a cold and you put up with it for a week or 10 days and you’re fine. You have to get treatment. And it’s so much more beneficial all the way around — to the child, to their family, to taxpayers — if dental problems can be prevented.”

While the state appears to be making strides in improving its numbers, part of the problem is the paucity of dentists willing to see Medicaid children. Only 10 percent of Colorado’s 3,500 or so dentists are considered “significant” Medicaid providers, meaning that they are reimbursed for at least 100 visits per year. Moreover, 20 of Colorado’s 64 counties do not have a dentist who accepts Medicaid.

A large part of the problem has to do with a lack of knowledge regarding essential health care benefits, which leads to the vast majority of Americans not claiming preventative dental care that they are eligible for. “When she came along,” Wendie said of Torrie, “they gave me a (Medicaid) card and said it was for her doctor visits. They didn’t say dental or anything like that.” That’s nothing new when it comes to Americans and their preventative care benefits — only one in five Americans in high-deductible insurance plans know that much of their preventative care is free.


But as the Coloradoan’s article points out, it also has to do with Medicaid’s historically low reimbursements for doctors. Since states share a considerable amount of authority along with the federal government when it comes to determining Medicaid’s budget, the program is often an easy target for budget cuts. But those cuts carry with them a considerable human cost for some of America’s poorest residents. As ThinkProgress has consistently reported, that makes implementing Obamacare’s optional Medicaid expansion a medical imperative for the American poor — but as Torrie’s story shows, educating families about the care that they are eligible for is just as important.