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Massachusetts health care — wonky, with a healthy dose of reality

Good News - MassHealth Dental Benefit Restored

Good News - MassHealth Dental Benefit Restored

July 19, 2018

Oral Health = Overall Health


[Update - July 26 - The Governor signed the fiscal year 2019 budget into law, and did NOT veto the provision restoring periodontal care. The new benefits will start on June 1, 2019. HCFA is thankful for the Governor's support of this provision.]

Yesterday, the state legislature approved the Massachusetts state budget for fiscal year 2019, which started July 1 and runs through next June. Included in the bill was funding to restore MassHealth coverage of periodontal care - treatment of gum disease - for adults. The new coverage benefit begins in June 2019.

MassHealth is the state’s Medicaid program, and covers 1.1 million adults. While children are guaranteed full dental care under federal law, states are permitted to make their own decisions about dental benefits for adults. Massachusetts previously offered adults comprehensive dental care, but in 2010 the benefits were severely cut. Over the past years, advocacy has resulted in benefits being restored on a piecemeal basis.

Restoring periodontal care is major step forward in improving both oral health and general health.  Periodontal disease is a chronic bacterial infection of the gums and bone that surround teeth. When left untreated, this disease causes irreversible gum and bone loss, leading to tooth loss. It also directly impacts chronic disease outcomes including those of diabetes, heart disease, and stroke. Periodontal disease can also lead to low birth weight and premature birth.

Additionally, the lack of comprehensive adult dental coverage wastes millions of dollars in extensive and costly services in emergency and inpatient hospital settings and places an added burden on MassHealth and the Health Safety Net. In its report from August 2016, the Health Policy Commission found that MassHealth members disproportionately use ED visits for preventable oral health conditions, including periodontal disease, at a cost four to seven times the cost of a dental office visit. Non-elderly adults on MassHealth use the ED for preventable oral health conditions seven times more frequently than commercially-insured adults.

The decision to restore MassHealth coverage of periodontal treatment for adults is a major victory for HCFA and the Oral Health Advocacy Taskforce  which we lead. The Taskforce, a broad coalition of consumer groups, dental  providers and health organizations has been working on improving oral health in Massachusetts, including a focus on restoring adult dental benefits.

The budget also funds the DPH Office of Oral Health at just over $2 million, and includes a $300,000 grant to the Forsyth Institute for the ForsythKids program.

Now the Governor has10 days to approve or veto budget items. Any vetos can be overridden by a two-thirds vote of both branches.