Editorial: Expand Medicaid dental services

In 2009, as the state struggled to make ends meet during the Great Recession, Hawaii cut dental care funding for adults insured by Medicaid. This has been catastrophic for many islanders who live with extremely limited incomes. With no affordable way to get treatment, those who developed painful dental problems or gum disease had nowhere to turn, other than a hospital emergency room.

The time is now to bring back crucial dental services, and also provide for restorative care such as root canals for adults in need, and who may not have been able to see a dentist in 10 years or more.

Funding adult dental care can go far in addressing Hawaii’s status as one of the worst states for oral health. The state has a responsibility to its most-vulnerable residents to provide access to this critical health service.

At present, the state limits dental care for adults on Medicaid to emergency treatments when people experience severe pain, develop oral infections or suffer serious injury. This shifts the burden to emergency rooms, and at great cost.

Between 2016 and 2020, 29,536 adults visited an emergency room for a dental-related problem. This created a $54.37 million bill, and $21.7 million of it was paid for by Medicaid, according to a 2021 study by the John A. Burns School of Medicine/Hawaii Oral Health Coalition.

At about 25% of Hawaii’s population, Medicaid recipients take up 49% of all dental services provided by ERs statewide, according to the study.

Providing adult dental care earlier could save from $1.9 million to $5.3 million annually in Medicaid costs — not only savings from fewer ER visits, but also reduced costs for complications of diabetes and coronary artery disease that result from poor dental care.

It’s a sad truth that cavities, gum infections and bone loss are related to lack of access to dental care. Research shows that disability and even death can be a result, when this poor oral health is combined with chronic illness.

Native Hawaiians and Pacific Islanders are disproportionately vulnerable to this problem, a situation that is unacceptable for our island state.

Hawaii is in a good position to take action this year, with a faster-than-expected recovery from pandemic-related troubles underway and expanded federal funding swelling the coffers.

Gov. David Ige included funding for basic services to adults on Medicaid in the 2023 executive budget: approximately $3.5 million in general funds and $6.7 million in federal funds, according to the Department of Budget and Finance. This would open the door for a significant number of the state’s adults in need to see a dentist for exams, X-rays, fillings, and prevention or early treatment of infections.

House Bill 1754 and Senate Bill 1294 aim to go further, funding basic dental care and restorative care such as root canals, and call for leveraging all grants and federal funds available. On Thursday, the Senate money committee released its draft of a state budget that include just over $8.8 million in general funds and $17 million in federal funds to meet this need. That’s encouraging.

With 1 in 5 Hawaii adults receiving health care assistance from Medicaid, there’s a good chance that you, your friend or neighbor could benefit from access to dental care if improved funding comes through. This will improve overall health and well-being in the islands.

The Legislature should see to it that dental services for Hawaii’s adults in need are funded and made available at the first opportunity.