Let me start off by claiming by own personal bias based on blatant fraud and waste I saw in dental school. Adult medicaid should cover extractions only except at learning institutions, we have to learn on someone after all.
Bill Blatchford once said that the only NEED based service we provide is extraction and everything else is elective. I believe that statement is dead on. That has been my foundation philosophy for practicing both before and after hearing him say that. I believe we are in the service industry as much as health care, as people can and do live long, healthy, happy lives missing some or many teeth.
As to the argument I have seen that cutting medicaid adult dental services costs more money because people end up in the ER more, I do not think the data supports anything close to that. Without a doubt more people will end up in the ER for dental issues if you cut the care but from a strictly cost analysis side the states still save money (likely a lot). Take California for instance. They cut adult medicaid dental care in 2009. The dental visit costs to ER increased by $1.3 million. Considering they cut care to 3.5 million people that is a VERY small number. I am unable to find what it cost the state to insure 3.5 million people but I think it is very safe to say the $1.3 million likely didn’t even cover the employee costs of managing the system, let alone the care itself.
Missouri just reopened adult medicaid for adults after not having for a decade. They set aside $14 million to cover 250,000 people. California is more expensive then Missouri but for arguments sake assume same and extrapolate out and California is likely spending $196 million on adult medicaid. Factoring in California’s increased ER costs they get a savings of about 99.5%.
Of note is that Missouri claims not having dental costs the state $30 million in increased costs. Obviously either the above Iowa study or the Missouri study is way off. I lean towards the Missouri one because many of those doing the study likely have a vested personal and financial interest in seeing Medicaid in there state (hence highly bias).
A newer study in Health Affairs showed that when adult dental medicaid was added there was no savings at all to emergency rooms. They hypothesize that this is due to low acceptance rates of medicaid by dentists means that any expansion of the program alone is useless since participating dentists are hard to find. That will not change unless the reimbursement rates rise drastically. Frankly it is widely accepted in our industry that unless you are being overly aggressive or committing minor to major fraud you can not afford to run a medicaid practice. Unfortunately, it is not hard to find businessmen willing to run practices staffed by young and inexperienced dentists or dentists desperate for work and force them to heavily over-treat societies most vulnerable population (children on medicaid).
Using the argument it costs money to not give out medicaid adult dental care is intellectually dishonest and is promoted by special interest groups within my profession. I am open to being proven wrong on the financial side if anyone can supply honest numbers and that is taking an honest look at the situation.