Ohio Health Policy News

Proposed changes in Medicare rules could soon pave the way for a significant expansion in Medicare-covered dental services, while falling short of the comprehensive benefits that many Democratic lawmakers have advocated (Source: “After Congress fails to add dental coverage, Medicare weighs limited benefit expansion,” Kaiser Health News via Ohio Capital Journal, Oct. 18, 2022).

Under current law, Medicare can pay for limited dental care only if it is medically necessary to safely treat another covered medical condition. In July, officials proposed adding conditions that qualify and sought public comment. Any changes could be announced in November and take effect as soon as January.

The review by the Centers for Medicare & Medicaid Services follows an unsuccessful effort by congressional Democrats to pass comprehensive Medicare dental coverage for all beneficiaries, a move that would require changes in federal law. Sen. Bernie Sanders (I-Vt.) sought in vain to add that to the Democrats’ last major piece of legislation, the Inflation Reduction Act, which passed in August. As defeat appeared imminent, consumer and seniors’ advocacy groups along with dozens of lawmakers urged CMS to take independent action.

Dentists have long been frequent prescribers of immediate-release opioids like Vicodin and Percocet for the pain from tooth extractions, but many in the field are now reassessing their prescribing habits, with state dental boards and associations issuing new guidelines for patients and practitioners (Source: “Dentists Work To Ease Patients’ Pain With Fewer Opioids,” Kaiser Health News, March 8, 2017).

For many patients, these drugs never pose a problem. But the deaths of some 165,000 people in the U.S. in the past 15 years involving an overdose of heroin or opioids, and the many other people struggling with addiction, have led officials to consider ways to curtail their use.

A 2011 study in the Journal of the American Dental Association estimates that dentists are responsible for 12 percent of prescriptions for fast-acting opioid pain relievers — just below general practitioners and internal medicine doctors as top prescribers of common opioids.

The Governor’s Office of Health Transformation and the Ohio Department of Health today released a draft of the 2016 state health assessment.

The state health assessment is a comprehensive and actionable picture of health and wellbeing in Ohio. The purpose of the state health assessment is to:

• Inform identification of priorities for the upcoming state health improvement plan
• Provide a template for state agencies and local partners (uniform set of categories and metrics to use in related assessments)

The report includes information from several sources in order to provide a comprehensive picture of health and wellbeing in Ohio. Using existing data, this document presents data profiles on health outcomes and a broad range of factors that impact health outcomes, healthcare spending and disparities. These data profiles are followed by summaries of new information collected for this assessment, including qualitative information gathered through key informant interviews and regional forums. The Health Policy Institute of Ohio was commissioned to facilitate the state health assessment process and produce the publication.

The public is invited to provide input on the state health assessment until noon on July 5, 2016.

The final state health assessment is expected to be released later this summer, followed by the release of the 2016 state health improvement plan later this year.

Federal data released this week shows that cavities in preschoolers appear to be declining and fewer young children have untreated dental decay (Source: “Untreated Dental Decay Is Falling Among Children,” New York Times, March 5, 2015). 

According to the report from the Centers for Disease Control and Prevention, it’s the first drop in dental decay among young children since 2007, and the lowest percentage in a quarter century.

The agency found that 23 percent of children ages 2 to 5 had cavities from 2011 to 2012, down from 28 percent from 1999 to 2004.

Dr. Bruce Dye, the lead author of the past two C.D.C. reports on oral health, said that “only 10 percent of preschooler kids have untreated tooth decay… This is the lowest percentage we have seen in the past 25 years.”

A study released this week found that between 2009 and 2011, at least 84,000 people annually went to Ohio emergency departments seeking care for dental pain (Source:  “Thousands still using ERs for dental problems,” Cincinnati Enquirer, Oct. 8, 2014)

According to the UHCAN Ohio study,  Medicaid ends up paying millions of dollars for people seeking emergency help for broken teeth, cavities, gum disease or abscesses left untreated too long. Often, the treatment fails to solve the underlying dental problem.

“The patients most likely to be using the emergency room for dental care are the least likely to have regular access to a dentist,” said David Maywhoor ,project director for Dental Access Now, an arm of UHCAN Ohio, a health-care advocacy organization in Columbus.

According to the study, from January 2010 until June 2011, dental treatment in emergency rooms cost $188.5 million in Ohio. About half of the visits are billed to Medicaid or Medicare; the other half are paid out of pocket.

Both the Ohio House and Senate are considering bills aimed at expanding access to dental care in Ohio, especially in rural parts of the state (Source: “Legislation would make dental care more accessible for under-served Ohioans,” Cleveland Plain Dealer, April 16, 2014).

Senate Bill 327 and House Bill 463 would allow more dental assistants to work under the supervision of a single dentist and allow assistants to provide services when the dentist is not in the office. The bills also include making dental students eligible for more state-sponsored scholarships and increasing dental licence fees to pay for an increase in funds to the Ohio Dental Loan Repayment program for dentist who work in rural and under-served parts of the state.

"There have been 84 parts of our state identified as 'Dental Shortage Areas,' making it difficult for Ohioans in those regions to have access to quality dental services we know are so important to overall health," said Sen. Joe Uecker, a Miami Township Republican, who sponsored the Senate bill. "What we are doing through this bill is to streamline access to dental care by addressing multiple barriers that result in the current shortage."

Rep. Terry Johnson, a McDermott Republican and physician, sponsored the House version.

Researchers at Case Western Reserve University have found a link between obesity and cavities among poor children (Source: "Dental issues have big effects in poor kids," Columbus Dispatch, Dec. 30, 2012).

“It’s not the obesity causing the cavities or the cavities causing obesity,” said Peg DiMarco, an associate professor of nursing and the author of the study, which examined health data of homeless children in Akron. “Poverty is the underlying cause of both.”

The study of homeless children in Akron, which was published last year in the Journal of Pediatric Health, concluded that a lack of access to fresh, healthful foods and to basic dental care is the cause of both problems.

While the dangers of childhood obesity are well documented, DiMarco said poor dental health receives much less attention. "Cavities are a silent epidemic, and they’re the No. 1 chronic infectious disease in children,” she said.

Without the ability to decrease Medicaid eligilbility in recent years, states have instead began reducing optional benefits for adults as a way to face financial shortfalls. And the benefit most likely to be cut is dental coverage (Source: "Sharp Cuts in Dental Coverage for Adults on Medicaid," New York Times, Aug. 28, 2012).

According to a recent study by the Kaiser Family Foundation titled "Filling the Gaps: Dental Care, Coverage and Access," in about half of the states, Medicaid now covers dental care only for pain relief and emergencies.

Dental benefits have been reduced or eliminated in both Republican- and Democratic-controlled states and will likely not improve under the Affordable Care Act, which requires dental coverage only for children.

A national study released this week by the Pew Children’s Dental Campaign gave Ohio a “B” in dental care for children  (Source: “Ohio gets only a B in dental care for children,” Cleveland Plain Dealer, May 24, 2011).

Making Coverage Matter  (pdf, 32 pages) is an annual report card for child dental care in all 50 states. This year’s report gave 27 states grades of A or B (Maryland had the highest rating) and 23 states and the District of Columbia a C or lower.

Ohio kept the same B average it got last year, and, like last year, scored above national standards in five of eight benchmarks.

According to the state’s report card, Ohio “faces significant challenges with its dental workforce. At least 1 million Ohioans live in 59 areas federally designated as having a shortage of dentists.”

Researchers at the Ohio Department of Health and the Health Policy Institute of Ohio have released a data brief, titled “Oral Health Findings from the Ohio Family Health Survey, 2008,” (pdf, 2 pages) examining dental care in Ohio, using data from the most recent Ohio Family Health Survey.

The report found that regardless of family income status, dental care was the most pressing unmet health care need for both adults and children.

Some of the findings include:

• 479,000 Ohio children (or 18.3 percent) were without dental insurance, compared to 111,000 children (4 percent) who were uninsured for medical care
• Even though low-income children (those in families earning less than 200 percent of the federal poverty level, or $41,300 for a family of four) had higher rates of dental coverage, they were less likely to have a dental visit in the past 12 months (68 percent of low-income children, compared to 81.5 percent of higher-income children)
• 3,433,000 (or 39.4 percent) of Ohio adults 18 and older reported having no dental coverage, compared to 1,232,000 (or 14.1 percent) of adults who reported being uninsured for medical care
• For adults, family income and job status are associated with a lack of dental coverage