Because Medicaid dental coverage for adults varies greatly among states, beneficiaries face inadequate and uneven access to oral health care. Even among children, who have guaranteed comprehensive oral health benefits under Medicaid, access to care is limited. As a result, Medicaid beneficiaries often have untreated dental disease that can lead to severe pain, emergency department use, and social consequences such as reduced employability.
In response, states are increasingly using creative value-based payment strategies to integrate oral health care into broader delivery system reforms. The focus on oral health has been particularly notable among states receiving Center for Medicare and Medicaid Innovation’s State Innovation Model (SIM) grants. Additional states not participating in SIM are also seeking to improve oral health care access for Medicaid beneficiaries by integrating dental care into primary care delivery.
This brief, made possible by the Washington Dental Service Foundation, explores how states are including oral health in payment and delivery system reform. Drawing on discussions with federal officials, SIM project leads, and state-level oral health experts, this brief explores promising opportunities in three areas:
- Medicaid benefit design and expansion;
- Practice-level oral health reforms; and
- Statewide delivery reform models.