When North Carolina expanded Medicaid this month, giving more than half a million people access to state-sponsored health care, those new beneficiaries could have even brighter smiles.
The state’s Medicaid program offers comprehensive oral health benefits, including routine cleanings, exams and other preventive services. Treatment deemed medically necessary includes some oral surgery, periodontal treatment, tooth restoration, denture adjustments and fittings – full replacements every 10 years and partial replacements every five years.
However, some of those new smiles may turn to grimaces as new Medicaid beneficiaries try to get dental appointments: Only about 45 percent of dentists in North Carolina accept Medicaid patients. Additionally, many of these dentists are not accepting new Medicaid beneficiaries.
Oral health care providers and advocates say there are myriad reasons for providers to accept new patients on Medicaid rolls. According to them, the big thing is that the compensation rate has remained the same for 15 years.
“The North Carolina Medicaid dental provider network is in serious crisis,” Frank Courts, president of the North Carolina Dental Society Council on Oral Health and Prevention, wrote in a letter to the editor recently published in the Neuse News and other publications. “…With the Covid pandemic and the resulting inflation, the actual costs of providing dental care are significantly higher than Medicaid reimbursement rates, which are at the same level as in 2008.”
For years, dentists have tried to remind insurance companies and other healthcare providers of the importance of recognizing the connection between oral and systemic health.
Poor oral health can have negative effects on conditions such as heart disease and stroke, diabetes, pregnancy and dementia, research shows.
“The people of North Carolina deserve an oral health care system that promotes their overall health,” Courts added. “It is up to state leaders to find ways to adequately fund dental care for Medicaid recipients. Doing so will save the state money in the long run and lead to a healthier and more productive population.
Zachary Brian, assistant professor and director of the Dentistry in Service to Community program at the UNC Adams School of Dentistry in Chapel Hill, told NC Health News in a phone interview this week that he is “over the moon” that North Carolina is now one of 40 states , who have an expanded Medicaid benefit.
“Politics is slow, it can take longer than we want,” Brian said. – After all, this should be celebrated.
How we got here
The Republicans who lead the state Senate and House of Representatives opposed the expansion for a decade, despite the efforts of Democratic Governor Roy Cooper.
Senate Majority Leader Phil Berger, a Republican from Eden, changed his mind and told his chamber in 2022 that expanding Medicaid was “the right thing to do.” His move to expand also came after the Biden administration put billions of dollars in federal stimulus on the table.
However, Parliament was not fully involved that year, partly due to other health policy changes related to the proposal.
In 2023, both chambers agreed to pass the amendment, but attached the extension to the approval of the state budget, a document that contained policies and changes that Cooper did not support.
Nevertheless, Cooper allowed the budget to become law without his signature, and enrollment of new Medicaid beneficiaries began on December 1.
Now, Brian and other oral health care providers are working to make sure new Medicaid enrollees can get the full benefit.
Looking at the challenges
Even if all dentists who accept Medicaid patients did so, it would not be enough to treat the 600,000 people expected to be added to the rolls. In addition, there are fewer dentists and dentists in rural areas than in urban and suburban areas of the state.
For several decades, North Carolina ranked in the bottom half of states for the number of dentists per 10,000 people.
In a 2001 report by UNC Chapel Hill’s Cecil G. Sheps Center for Health Services Research, North Carolina had just 4.2 dentists per 10,000 residents, ranking it 47th. By 2013, North Carolina had risen to 44th in the nation with 4.8 dentists per 10,000, and four years later the state was 37th in the nation. In 2022, the state ranked 24th in the country with 5.6 dentists per 10,000 residents. The national average was 6.1 dentists per 10,000 inhabitants.
All but six of the state’s 100 counties are dental health care professional shortage areas, according to a map created by the Rural Health Information Center with data from the federal Department of Health and Human Services.
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