So good teeth help you land a good job, right? According to research, yes. A 2008 Columbia University study called “The Economic Value of Teeth” linked better oral health to higher wage earnings, mostly for women; and one of the authors of a 1994 study published in the American Economic Review -- who later wrote the book Beauty Pays -- has very publicly pronounced that good teeth make people more attractive and therefore more employable.
That’s why despite having a squeezed Medicaid budget, Massachusetts restored cosmetic dental coverage for its beneficiaries last year. The state had cut $80.6 million from its adult restorative dental benefits, which included things like root canals and dentures, in FY 2011. The next year, however, the state added a few services back -- in particular, fillings for front teeth -- not only because the state coffers had started to rebound, but because officials saw those benefits as a tool to boost the economy.
“Part of the rationale for [restoring benefits] was the perspective, which is supported by literature, that individuals who have a poor dental condition have a difficult time of finding a job,” says Julian Harris, director of the Massachusetts Medicaid office. “This would help our members to enter and stay in the workforce and to contribute to the economic development of the commonwealth.”
This year, Gov. Deval Patrick has proposed fully restoring comprehensive adult dental benefits to the Medicaid program for the second half of FY 2014 -- a move that will cost the state about $69 million.
According to a policy report by the American Dental Association, only 13 state Medicaid programs (which no longer includes Massachusetts) currently provide comprehensive adult dental services while seven states offer no dental coverage for low-income adults at all.
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While it’s difficult to know if viewing Medicaid dental coverage as an economic development tool is a notion that will catch on, there are reasons to think that it could or, at least, should. The program’s population is low-income, often in an unstable work environment or fluctuating between having work and looking for it.
“There are people who would say: ‘The best health outcome is getting a job. The best economic recovery is getting a job,’” says Matt Salo, executive director of the National Association of Medicaid Directors (NAMD). “This is a population that's much more in flux and perhaps less in control of their job destinies. So from that perspective, it does make some sense.”
But then there’s an unfortunate quagmire in play when it comes to Medicaid dental coverage: the relationship between Medicaid and dentists has historically been sour. From the dentists’ perspective, they’re tired of dental coverage being the first item on the chopping block when times get tough and states have to make cuts.
“There are only so many places you can cut,” Salo says. “If you have to cut benefits, adult dental benefits are in essence one of the only things that you can just get rid of.”
It was even true in Massachusetts. Dental cosmetic services were one of the first things to be cut when the economy tanked, and, if approved this year, it will be the last thing to be restored.
On the other side, though, Medicaid offices are often frustrated by what they say is unwillingness on the part of providers to participate in the program at all. The payment rates aren’t always great and the paperwork can be onerous, says Salo, but the rest of the health-care sector has found a way to work with Medicaid. He then described sitting in on discussions with dentists who more or less said that they didn’t want Medicaid beneficiaries in their offices. Access has become a problem for Medicaid in general, and that’s equally true for dental services. No official figures exist, but in a 2011 federal survey, only one state out of 41 reported that more than half of its dentists had treated at least 100 Medicaid patients in the previous year.
“Dentists tend to be the toughest nut to crack,” Salo says. “They want to take their ball and go home if they don’t get everything they want.”
Unlike its peers, though, Massachusetts has a strong relationship with its dental providers, and that's what makes the economic development angle work. Nearly half of the state’s dentists participate in Medicaid, and 96 percent of its beneficiaries have at least two dentists who accept Medicaid within their zip code, says Brent Martin, the state program’s dental director.
In exchange for their cooperation, the state has tried to address some of the dental community’s concerns about Medicaid's laborious processes and has instituted a unique provision that allows dentists to temporarily stop taking Medicaid patients if the lower reimbursements are hurting their bottom line.
“It’s been a real collaboration,” Martin says. “We’re totally aligned. We’ve agreed that it’s time to give back to the patients.”
Checking Up on Health News
The White House has taken Medicaid off the table in deficit reduction talks, The Hill reports, but according to NAMD's Salo, it's not time to relax just yet. "It's reassuring. It's saying the right things. It's putting states in a better position to make decisions. Is it a guarantee? Absolutely not." The Medicaid expansion debate is getting tricky. As The Washington Post reports, states that don't expand could end up giving their citizens less health coverage than legal immigrants. South Carolina wants to stop food stamps from being used to buy soda, The State reports. But they'll need a federal waiver to do it. This is a very long, but highly recommended read from Guernica magazine on the legal, ethical and moral questions raised by a hunger-striking prisoner in Connecticut. Lastly, as health and education are often linked, check out this El Paso Times series on the cheating scandal that's rocked the city's school district. Governing honored one of the reporters last week with our Hovey-Harkness award, which recognizes excellence in investigative political journalism.