Dental issues go beyond what the eye can see. That was the case for a 44-year-old Native Hawaiian woman who practiced regular brushing, self-care and proper nutrition. She had a nice smile, but in the past year had noticed bleeding, redness of the gums and bad breath. Without dental insurance, and unable to afford out-of-pocket payments, she finally visited a dentist after 10 years. X-rays revealed that her symptoms were being caused by severe gum disease.
The dentist recommended a referral to a periodontist due to extensive bone loss on her back molars, but the patient could not afford treatment or surgery to save her teeth. Without specialized intervention, she would likely lose six teeth due to the irreversible bone damage. This woman’s worsening periodontal condition would have been spotted and treated if her Medicaid health coverage had included routine dental visits.
Unfortunately, this and similar preventable oral care experiences are far too common for approximately 223,438 Hawaii adults who rely on Medicaid for their health insurance. That’s because in 2009 — during the massive across-the-board budget cuts to state programs due to the Great Recession — routine adult dental care was dropped as a covered service and never restored.
This dental benefit, something many of us take for granted including twice yearly teeth cleanings, X-rays and fillings when needed, is not an option for adults on Medicaid — about 1 in 5 Hawaii residents — a shockingly high number. Their only covered option for dental care is an emergency room visit.
As we enter the third year of the COVID-19 pandemic, a more hopeful situation is taking shape. Because Hawaii’s revenues took an unexpected turn for the better, the state Legislature has the opportunity to approve additional funding for the Department of Human Services to restore oral health services for Medicaid coverage. In the last year alone, within the midst of the pandemic, Medicaid enrollment increased by 100,000 residents.
As a community of health care advocates, we know that adult dental care is a critical service for our vulnerable populations. Funding preventative and basic dental coverage will uplift people’s overall health while also easing the burden on stressed emergency rooms.
According to a 2021 study by the Hawaii Oral Health Coalition, in partnership with University of Hawaii’s John A. Burns School of Medicine, between 2016 and 2020, 29,536 adults visited the ER with a dental-related diagnosis at a total cost of $54.37 million, of which $21.7 million was paid for by Medicaid. This is a high cost and burden on our emergency rooms, and an even greater societal cost causing much human suffering.
What can be done to turn the situation around and put people’s health first? The DHS proposed budget includes $3.4 million in state funds plus a $6.7 million federal match for basic dental coverage. That excludes any cost savings from keeping people out of emergency rooms. A 20% utilization rate at current enrollment levels would equate to just $182 per person — not an ideal amount. But after 13 years, it’s a small yet meaningful step in the right direction to improving health care in Hawaii. We are hopeful the state Legislature will consider more substantial funding.
By approving the proposed budget and restoring adult Medicaid dental coverage for diagnostic, preventative and restorative care, the Legislature can help reframe the meaning of whole person health while addressing the health needs of vulnerable populations. It is time to stem the tide of preventable disease and invest in our people and their health.
Dr. Anthony Kim is a Honolulu dentist who submitted this on behalf of the Hawaii Oral Health Coalition.
