California is one of 23 states and the District of Columbia that provides comprehensive oral health care for adults in Medicaid. Federal proposals to cut Medicaid funding to states would place this coverage at risk, and threaten the oral health of nine million adults enrolled in Medi-Cal (California’s Medicaid program).
The Important Role of Oral Health
Poor oral health, like tooth decay and gum disease, can cause significant pain and impact the ability to eat, speak, and focus. The impact of poor oral health also extends beyond the mouth. Research clearly shows that poor oral health is linked to various chronic conditions, including diabetes, heart disease, and most recently Alzheimer’s and dementia. Poor oral health can also increase the risk of experiencing a stroke and adverse pregnancy outcomes.
Access to oral health care is particularly important for the Medi-Cal population. Data shows that people on Medi-Cal report poorer oral health. Similarly, adults of color in California report having poorer oral health than white adults in California.
Medicaid Cuts Threaten Access to Oral Health
Under federal law, states have the option, but are not required to cover adult dental benefits in their Medicaid programs. Today, all but one state has opted to provide adult dental coverage to some extent.
However, when states experience budget shortfalls, they often cut optional benefits first, with dental coverage being one of the most vulnerable. California eliminated adult dental coverage in 2008, leaving most Medi-Cal enrollees without access to dental care from 2009 to 2014, except for residents in institutional settings and pregnant women. While dental benefits were partially restored in 2014 and fully restored in 2018, the consequences of the elimination continue to reverberate today, serving as a warning of what’s at stake if California’s Medicaid funding is cut.
The Harms of Cutting Oral Health Are Significant
Cutting oral health care would have profound and far-reaching consequences.
- Health and Well-being. One of the most immediate harms of cutting oral health coverage is the impact on the health and overall well-being of Medi-Cal enrollees, who without coverage cannot afford to obtain care. When coverage was eliminated in 2009, Medi-Cal enrollees delayed care and increased their use of emergency treatment in emergency rooms and primary care offices for issues that could have been addressed earlier. This not only placed their health at risk and caused unnecessary pain and suffering, but it also diverted care to settings less equipped to provide quality dental treatment and that are more costly, increasing costs for the state.
- Access and Disparities. Cutting oral health services would set back the progress that California has made in increasing access to dental care and addressing existing disparities. It has taken California years to rebuild utilization rates after past cuts. Similarly, California has also invested significant resources to build the oral health workforce and availability of providers. While disparities in access based on race and other demographic factors persist, gains have been made. Cutting oral health access would reverse these gains, leading to a loss of providers and limited access to essential dental care, particularly for marginalized communities.
- Economic Security. Cuts to oral health have a detrimental impact on the economic security of the most at-risk Californians. Medi-Cal enrollees have very low incomes. To pay for oral health care means having to forgo other essential needs. Poor oral health can lead to increased absenteeism and impact a person’s ability to work, resulting in financial strain for both individuals and families.
Bottom Line: Protecting Medicaid is Essential for Oral Health
In summary, any loss of federal Medicaid funding in California jeopardizes access to oral health care, which is critical for maintaining overall health and well-being. Loss of Medicaid funding extends beyond budget constraints with significant implications for health outcomes, economic stability, and health equity.
Real stories: What’s at Stake
One Medi-Cal member highlighted the profound impact that access to dentures had on their father’s quality of life. Without the support of Medicaid funding, many Californians—particularly older adults and low-income people of color—would struggle to access essential oral health care, jeopardizing their overall well-being and independence.
Another Medi-Cal enrollee initially sought emergency dental care. Because of Medi-Cal’s coverage of oral health, she was connected to more extensive treatment including a full mouth examination, restorative treatments, and ongoing preventive visits. She expressed heartfelt gratitude for the Medi-Cal program, which played a vital role in maintaining her oral health.
