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Many Of Virginia’s Medicaid Plans Don’t Cover Adult Dental Care, But Lawmakers Might Change That

dentist examines teeth
Medicaid plans cover dental services for youth, but most plans don't cover dental for adults in Virginia.

Right now, Medicaid in Virginia doesn’t cover hardly any dental work for adults. A group of Democratic lawmakers are discussing ways to help more low-income Virginians get access to dental care

Robert Savoy is on an advisory committee for Virginia’s Medicaid agency, and has also had healthcare coverage through Medicaid for a few years. One area he hasn’t had coverage, though, is for dental care.

“Beyond the filling and the cleaning, sometimes people need root canals,” Savoy said.

Rachel Pryor, deputy director of administration for Virginia’s Medicaid agency (DMAS), says she’s heard from Medicaid members who’ve had a hard time finding a job because of lack of dental coverage, especially when it comes to the interview. 

“It’s really hard to find a job if you can’t present yourself with a healthy smile,” Pryor said.

And often, Pryor says, it's only emergency dental situations that are covered.

“So if you have an emergency medical situation where you need to pull a tooth, the tooth can get pulled but there's not necessarily a guarantee that that tooth would be replaced with another tooth," Pryor said.

Ellen Montz, new chief deputy director for DMAS, says some Medicaid plans offer more dental coverage than others. Medicaid members can compare those different plans on the state agency’s website.

“Plans can choose to offer additional benefits whether that's because they want to attract people to choose one plan over another, or whether that’s because it makes economic sense in terms of: does getting regular cleanings prevent that emergency dental situation in the future that is rather costly,” Montz said.

Democratic Delegate Ibraheem Samirah is a dentist. He said for dentists who work independently and have their own small dental offices, accepting the current Medicaid reimbursement rates is difficult. He says some dentists might be willing to accept a lower reimbursement rate for shorter, simpler procedures, especially for seniors. 

“Things like dentures and extractions: elderly individuals could benefit greatly from it,” Samirah said. “Reduce cancer, oral cancer, all sorts of digestive cancers. It could improve an individual’s eating habits and just in general nutrition-wise, it’s a huge difference.”

Samirah says it’s something he’ll be pushing for in the future, but not at the moment. He says a higher reimbursement rate for dentists would be necessary in order to expand Medicaid dental coverage beyond these services in part because of the high costs of materials in the dental world.

“The standard cost that we refer to is the price of a crown, the most basic procedure that happens after we do a root canal on a tooth," Samirah said.

Samirah says the average cost to put in a crown is around $2,000. The Medicaid reimbursement rate in states he studied in is around a quarter of that.

“The material itself costs around that price ($500-$600),” he said.

Samirah isn’t sure how far the issue will make it during this legislative season, even with Democratic control of the House and Senate. But, he says it’s an important issue that lawmakers need to take seriously.

“You can't possibly function if you are not able to eat effectively," Samirah said. "They're so many reasons to have good oral health."

Megan Pauly reports on early childhood and higher education news in Virginia
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