Dental Coverage Under AHCCCS: A closer look at the key public institutions and policies

Let say our bill makes it through Congress. You might be thinking, great!, but where does the money come from to pay for dental coverage for all of the pregnant women who qualify for Arizona’s Medicaid (AHCCCS)? As of October of 2018, there are 1,693,508 Arizonans who receive Medicaid for health insurance (Centers for Medicare & Medicaid, n.d.b). That is 24% of the population of Arizona and an increase of 40.92% since the implementation of the Affordable Care Act (ACA) Medicaid expansion in 2013 (Centers for Medicare & Medicaid, n.d.b). Let’s say half of those with AHCCCS are women, and I would bet a good majority of them are of childbearing age. That is a lot of women who will benefit from this coverage and since money doesn’t grow on trees, that coverage has to come from somewhere. We know that the budget was the biggest barrier and the ultimate reason that this bill did not pass last year (K. Earls, personal communication, January 30, 2019).

A little more about Medicaid

In order to understand this, we need to talk a little bit more about Medicaid and how it works. In 1965, the Medicaid program was born to help those with lower incomes pay for health care services (Longest, 2015). Medicaid is a federal program that is run by the state, and funding comes from both federal and state tax money. The amount of federal funding varies by state, but they must match at least 50% of what the state is spending (Longest, 2015). In Arizona, 75% of the budget comes from the federal government [that is a lot!] (Arizona Health Care Cost Containment System [AHCCCS], 2017). Medicaid spending has increased steadily since 2006, and in 2017, the AHCCCS budget was about $11.4 billion. About 2% of that budget was allocated to dental services, making up the smallest slice of the pie (AHCCCS, 2017). This increase in spending is great for the health of Arizona, but it needs to trickle down more into the oral health of Arizonans.

The expansion of Medicaid under the ACA had a large impact at the state level in increasing access to medical care across the country by increasing the amount of federal money allotted to each state’s Medicaid program (Longest, 2015). However, it did not directly impact dental health. Because this program is run by individual states, eligibility and benefits provided vary by state (Longest, 2015). It is up to each state to decide what they will cover and how they will divide up the money. There are, however, certain health care services that are required by the federal government to be included, including prenatal care and care up to 60 days postpartum, in order to receive federal funding (Longest, 2015). Unfortunately, dental coverage did not make that list of requirements. In Arizona, children up to age 21 have preventative dental care covered, but in general, adults do not (Centers for Medicare & Medicaid, n.d. a).

Previous Public Policies

There have been previous state policies for adult dental care coverage under AHCCCS that have sort of “set the stage” and led us to where we are now with this pregnancy dental coverage bill. The first is the dental coverage for disabled adults (K. Earls, personal communication, January 30, 2019). This coverage was taken away in 2006, leaving many adults with physical and mental disabilities without oral health care. In 2016, this coverage was restored after years of persistence from many of the important political actors that I discussed in my last blog. The other important policy is the one that covers emergency dental care for adults. This policy was eliminated in 2010 and was just restored in 2018 with an equal amount of persistence and effort (K. Earls, personal communication, January 30, 2019). The passing of these two recent policies really highlighted the importance of oral health to overall health and brought the issue of the importance of dental care coverage to the attention of the policy makers.

The following link provides a more detailed look at what care is covered under AHCCCS: https://www.azahcccs.gov/AHCCCS/AboutUs/programdescription.html

References

Arizona Health Care Cost Containment System. (2017). AHCCCS fact sheet. Retrieved from https://www.azahcccs.gov/AHCCCS/Downloads/AHCCCS%20budget.pdf

Centers for Medicare & Medicaid Services. (n.d. a) Dental care. Retrieved from https://www.medicaid.gov/medicaid/benefits/dental/index.html

Centers for Medicare & Medicaid Services. (n.d. b). Medicaid & CHIP in Arizona. Retrieved from https://www.medicaid.gov/state-overviews/stateprofile.html?state=arizona

Longest, B.B. Jr. (2015).  Health policymaking in the United States (6th ed.). Chicago, IL:  Health Administration Press.