Dental benefit for adults on Medicaid becomes a reality

·3 min read

Jul. 1—CONCORD — A long legislative campaign to provide adults on Medicaid with preventive dental care ended with Gov. Chris Sununu signing the legislation on Friday.

"This is something that has been talked about for a long time," Sununu said.

Delta Dental Chief Executive Officer Thomas Raffio added, "I've been at this for 25 years."

The plan affecting up to 120,000 low-income clients has had strong bipartisan support, but stalled in the past because House conservative legislators balked at the price tag for taxpayers to provide coverage.

"It's rare to achieve a public policy success that affects so many people," said state Sen. Cindy Rosenwald, D-Nashua, who authored one of two identical bills to create this benefit.

"This will lead to better health outcomes that over time will save costs."

The issue found its political sweet spot this year after House Republican leaders dropped their reluctance once they had found a handy revenue source for the first three years.

Last January, Centene Corp., one of the state's three firms providing managed care for Medicaid clients, agreed to pay $21 million to the state's inquiry into whether the company was overcharging for prescription drugs.

The bill (SB 422) claims all of that settlement money as the state's match that will leverage getting about $60 million in federal grants over those three years.

"We finally were able to find the right solution to provide this benefit in a transparent and sustainable way," Sununu said at a crowded signing ceremony in the Executive Council chambers.

Supporters recognize this benefit will not happen overnight; it creates a process for the state to award a management contract to start offering coverage on April 1, 2023.

"Today, we told our adults on Medicaid who are suffering from oral health issues that help is on the way," said Senate Majority Leader Jeb Bradley, R-Wolfeboro, who is one of the first GOP leaders to embrace this effort.

State needs waiver

Prior to the beginning of this program, the state Department of Health and Human Services must ask the Biden administration for a waiver so it can require adults on Medicaid to make a copayment.

Preventive dental care will be exempt from any copayment.

Until this change, Medicaid has only offered adults coverage to pull infected teeth.

The state in the future will cover annual comprehensive oral examinations, X-rays, treatment to prevent disease, topical fluoride, oral hygiene instruction, behavior management, and smoking cessation counseling.

This also will reimburse for replacement fillings along with oral surgery needed to relieve pain or eliminate infection.

The benefit would limit coverage for dentures to those on Medicaid with developmental disabilities, acquired brain disorders and those in the Choices for Independence program that supports seniors and other adults with chronic illnesses.

State Rep. Jess Edwards, R-Auburn, had argued that charging Medicaid clients a copayment would ensure they had "skin in the game" to improve their health.

"These accommodations allow the state to recognize that good oral health is beneficial to society, while respecting taxpayers who should expect sound insurance practices that avoid the gold-plating of services," said Edwards in a joint statement with Rep. Mark Pearson, R-Hampstead, chairman of the House Health, Human Services and Elderly Affairs Committee.

The state's dental community supported the legislation, but Rosenwald admitted there were "challenges" for this program to succeed.

To begin with, reimbursement rates have to be high enough to get dentists to agree to accept Medicaid patients, she said.

Dentists also want the program to pay for "care management" for these clients to avoid a high percentage of no-show patients who either forget about the appointment or fail to get transportation to it.

"We've got a lot of buy in from the industry so I'm optimistic we can overcome these challenges and have a very successful program," Rosenwald added.