On Jan. 1, a new budget measure went into effect to provide comprehensive dental coverage for adults on Medicaid and help close the health equity gap for 250,000 underserved Hawaii residents.
This is a victory for the many low-income adults and people with disabilities who rely on Medicaid for critical health care services in Hawaii. And it should be a call to action for other states to make access to oral health care more equitable for the millions of people across our country who lack this coverage.
In 2009, Medicaid adult dental coverage was cut from the Hawaii state budget, leaving a quarter of a million of adults here without access to preventive and restorative dental care.
Since then, advocates have been fighting to reinstate the coverage.
They formed the Hawai‘i Oral Health Coalition (HOHC), whose efforts came to fruition in May 2022, when the state Legislature approved a budget that included $25.9 million for Medicaid adult dental benefits.
While the progress in Hawaii is a monumental milestone, the work is not done. The advocate community has shifted its focus to implementation, including working with community dental leaders and other stakeholders to expand the dental workforce and identifying ways to encourage dental providers to accept Medicaid to prepare for the uptick in recipients seeking care.
The lack of coverage for adults in Hawaii was part of a much larger, national problem. According to data from CareQuest Institute for Oral Health, 77 million adults in the U.S. lack dental benefits, disproportionately impacting Black and Latino people, Native Hawaiian and Pacific islanders, tribal and rural communities, and people with disabilities.
The lack of dental benefits available to Medicaid-eligible adults contributes to this gap in coverage. While most states provide emergency adult dental benefits, providing coverage is optional and nearly one-third of all states don’t offer dental care beyond emergency procedures or have no coverage at all. This leaves adult Medicaid enrollees needing dental care with the untenable choice of going to an emergency department or suffering through pain.
Medicaid-eligible adults also experience significantly higher rates of diseases linked to poor oral health, compounded by a lack of access to necessary preventive oral health care.
The expansion of Medicaid coverage has undeniable economic benefits. Nearly 80% of emergency department dental visits, which costs the health care system $2.1 billion annually, are preventable and addressable in a dental office. In Hawaii, a study revealed that between 2016 and 2020, emergency department dental visits cost $38.7 million, with nearly half from adult Medicaid recipients.
Adults who obtain dental coverage through Medicaid also report improved oral health and employability. CareQuest Institute research found that ensuring dental care access to all working adults would create $14.2 million in federal tax revenue and save $7.9 million in unemployment benefits.
In reinstating dental benefits to adults with Medicaid coverage, Hawaii policymakers clearly recognize that oral health impacts overall health, wellness and even economic security.
While it’s been a long road to ensure that Hawaii Medicaid beneficiaries have access to this vital form of health care, this victory shows us that it is possible and worth the fight. This is a critical step toward improving access to care and creating a more equitable health system for the people of Hawaii — and a model that we hope others replicate nationwide.
Kaz Rafia is chief health equity officer at CareQuest Institute for Oral Health; Patrick Donnelly is statewide oral health coalition manager for the Hawai‘i Public Health Institute and the Hawai‘i Oral Health Coalition.
