Dental leaders are growing increasingly concerned about the impact the Medicaid redetermination process could have on patient care and accessibility.
More than 94 million people were enrolled in Medicaid and the Children's Health Insurance Program in March 2023. However, about 23.8 million people have been disenrolled since the continuous enrollment requirement enacted during the COVID-19 pandemic ended March 31, 2023.
The CareQuest Institute for Oral Health warned in April 2023 that more than 14 million adults could lose their dental coverage as part of the redetermination process. Recent analysis from the organization shows that about 12 million adults and children lost their dental coverage between April and September of 2023, with an additional two million people estimated to have lost coverage between September and December 2023.
CareQuest's Director of Public Policy, Melissa Burroughs, told Becker's that the loss of coverage could have a significant impact on overall health and health equity. Additionally, the loss of coverage could lead to an influx of patients seeking care at dental clinics servicing low-income and uninsured people, she said.
"This is extremely concerning that people are losing dental coverage in these numbers. We know there's a direct link between oral health and overall health and without affordable dental insurance, it's clear dental care will be unaffordable and out of reach for many folks," Ms. Burroughs said. "We're likely to see patients skipping care they need because they can't afford it. That may be that they're skipping preventive care [or] putting off care for major problems until they end up in the emergency room. It results in people not being able to get the care they need and worsening problems and making care more expensive down the line."
KFF's Medicaid disenrollment tracker estimates that about 69% of all people disenrolled have had their coverage terminated for procedural reasons, which can include people who did not complete the renewal process.
Bryan Carey, CEO of Atlanta-based DSO Benevis, said many patients are either unaware that their coverage has been terminated or are experiencing administrative challenges keeping them from accessing Medicaid coverage.
"It's extremely frustrating for us as a provider focused on pediatric Medicaid in particular because all the data we see says over 75% of those who have been disenrolled are in actuality eligible, but there have been administrative issues," Mr. Carey told Becker's. "What we have found is in many cases, 30% of the people who contact us to make an appointment turn out to no longer be eligible and then have to go through some sort of an enrollment process … It now turns out that a lot of the systems have errors in it. So not just the administrative burden where maybe the beneficiary didn't provide the right payroll or tax information, but the systems including those that are managed by Deloitte have been prone to a number of errors both in terms of just incorrectly informing people they're no longer eligible as well as just downtime as people try to address administrative issues.
In addition to these issues causing delays in care for patients and delays in payments for dental practices, this redetermination process could also lead to a loss in patients for practices accepting Medicaid.
"It's been at different levels in different states," Mr. Carey said. "In some places, it's been single digits. I think the most extreme in the states we're in has been in Texas, whereby our understanding, as much as 30% of the Medicaid enrollment has been disenrolled. We actually are seeing a double-digit decline in patient presentation in some of our Texas offices, which is directly attributable to people seeking to make appointments and then finding out they are no longer eligible."
Both Ms. Burroughs and Mr. Carey agreed that the disenrollments pull back on the progress that has been made in recent years to improve accessibility.
"The combination of the disenrollments, some of the exits including Walmart, coupled with the shortage of healthcare workers, it is becoming more difficult to have access and availability," Mr. Carey said. "It seems like there's the need for just a change in terms of a more proactive way of saying, how do you provide benefits to somebody who needs them and reduce the administrative burden of enrollment, particularly for children."
Ms. Burroughs said some suggestions for improving accessibility for patients who were disenrolled could include supporting patients through the re-enrollment process if they are eligible and expanding dental coverage in other areas, such as states adding dental care as an essential health benefit to their benchmark plans.
CMS issued a final rule to add routine adult dental services as an essential health benefit under the Affordable Care Act in April. The new rule allows states to add routine non-pediatric dental services as an essential health benefit to benchmark plans beginning in 2025.
Mr. Carey also suggested that age-based coverage requirements be enacted.
"I think we should move to the equivalent of Medicare where maybe just every child under 16 is eligible for Medicaid coverage. If they have private insurance that gives them more accessibility, great, but I think it should be almost age determined because it is such a consequence in terms of missing school and emergency room visits," he said. "We really need to do something different. To me, it's every child under 16 ought to have Medicaid dental coverage and if there's supplemental through a family's employment, then that's additive."
Mr. Carey said the redetermination process has highlighted a core issue about the effects of federal action in healthcare.
"There's a disconnect between the legislative intent and what's happening day to day," Mr. Carey said. "When Congress ended the public health emergency, [they] put in rules seeking to reduce the administrative burden, but there are gaps between the intent and what's happening, which is a combination of I don't think they really took into account the administrative burden of what it takes for a beneficiary to be able to prove they're eligible and then the unfortunate breakdown in a lot of the systems that has resulted in lack of ability to access the system or downtime of the systems."