At the beginning of this year, West Virginia began offering a dental benefit for adults over the age of 21 who are enrolled in West Virginia Medicaid. This was a result of SB 648, a piece of legislation passed in 2020 which the WVCBP, the West Virginia Oral Health Coalition, and many partners and community members advocated on behalf of. This new benefit covers diagnostic, preventive, and restorative services with a maximum benefit of $1,000 per eligible member per calendar year.
After six months of this benefit, we wanted to take a look at how it has impacted Medicaid members. Below, we provide a summary of overall utilization, as well as some insight from individual residents who were willing to share how access to these services improved their lives.
Nearly one in five adults in West Virginia gained access to dental benefits via Medicaid this year. Over the first five months of this new benefit, over 18,500 members have utilized newly available dental services, totaling almost $7.8 million in covered benefits and payments to dentists throughout the state. Given that all routine and preventive medical visits have been reduced due to pandemic implications, it is likely that the utilization of dental services is also lower than what it would normally be. Still, there has been robust usage of the benefit, and this usage will almost certainly increase as the pandemic continues to subside.
The varied utilization across the state reflects these considerations. Over the past several months, an average of 25 members per 1,000 eligible Medicaid users have utilized the expanded dental benefits. Some counties, like Berkeley and Jefferson, have had fewer than ten members per 1,000 use dental services. Meanwhile, in 14 counties — including Fayette, Gilmer, and Pocahontas — more than 30 members per 1,000 have utilized dental services. Estimates in the bill’s fiscal note projected that, on average, 20 percent of eligible Medicaid enrollees may utilize the dental program in a given year. However, as of June 2021, the state is averaging about 4.4 percent utilization, which could put utilization in the first year at about half of estimates.
|County||Members||Estimated Per 1,000 Member Utilization||Utilization in Dollars|
As the pandemic subsides, state officials expect utilization to move toward their initial estimates. The gap between expected and actual utilization also provides outreach opportunities in many counties with lower take-up that will help residents across the state become aware of the new benefit and access critical dental care. While it will take some time to disaggregate the collective impact of the dental program over time, preliminary evidence collected from individual experiences suggest both short- and long-term benefits.
We asked adult Medicaid beneficiaries to share with us how access to dental care had impacted their lives. One major takeaway was that many were still unaware of the new dental benefit, which signals the need for more robust outreach. We also heard from several Medicaid enrollees who had successfully utilized the program.
“Until last month I was a full-time student and worked part time for Marshall University.. I could never get an appointment at a [Federally Qualified Health Center] to pay cash. I had my teeth cleaned for the 1st time in 3 YEARS this February by my regular dentist!” -Jennifer, Charleston, WV
“I’ve had a lot of recovery clients who were able to get dental work done for the first time.” -Matthew, Buckhannon, WV
“I don’t know what would have happened to my teeth if I had gone another year without dental coverage. I knew I needed dental care, I even had nightmares about my teeth and jaw often. But the cost of care kept help out of my reach. I’m fairly young, but an issue with my gums had already started to wear away my teeth. I’d have probably lost several teeth before I was 40 without the intervention that is now available to me. Additionally I’m getting married in a few months and it’s just nice to look forward to smiling in my wedding photos.” -Sarah, Huntington, WV
Oral health has significant impacts on overall health and well-being. Poor oral health and lack of access to regular dental care in West Virginia contributed to higher emergency room utilization, as well as the worsening of chronic disease rates including diabetes and heart disease. Lack of access to dental care has also been associated with poorer mental health and employability challenges. Prior to adoption of this benefit, access to dental care was highly correlated with income, meaning that lower-income residents were much less likely to have visited a dentist recently and, thus, more likely to experience the negative health and job outcomes associated with lack of regular oral care. Rural populations are also less likely to have visited a dentist recently; in West Virginia, these impacts may have historically compounded residents’ experiences with accessing dental care.
Thanks to this new benefit, the state is likely to see overall health savings due to reductions in unnecessary emergency room care as well as improved chronic health outcomes. While the benefit is too new to see broad changes in health outcomes, we can already see the impacts for individuals who have taken advantage of this new program.
Looking ahead, it would be worthwhile for the Department of Health and Human Resources, the state’s managed care organizations (MCOs) who administer Medicaid benefits, and other interested advocates to continue outreach to Medicaid members, as there is still a significant percentage who are unaware of the benefit.
The West Virginia Oral Health Coalition has put together this informational postcard on the dental benefit if you’d like to help get the word out!
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