DECEMBER 8, 2020 BY HANNAH
KATCH PAUL N. VAN DE WATER
More than 88 million adults in the United States are enrolled in
Medicare or Medicaid.[1] Most
do not have comprehensive health coverage for vision, dental, or hearing
benefits, often leaving them without the care they need to protect their health
and quality of life. Congress increasingly appears to be considering adding
coverage for these services in Medicare — as it should. But in doing so, it
should also guarantee access to the same benefits for low-income adults with
Medicaid coverage.
Lack of access to dental, vision, and hearing care can pose serious
risks for overall health. The absence of routine care can delay diagnosis of
some serious health conditions, leading to complications and more costly
treatments later. For example, researchers have found that lack of dental coverage
in Medicaid leads to additional emergency department visits — dental-related
emergency department visits increased by 32 percent among adult Medicaid
enrollees in California after the state eliminated dental coverage in 2009.
Even when not associated with other health concerns, dental, hearing, and
vision problems can decrease individuals’ quality of life and impede
participation in their communities.
People with lower incomes are less likely to be able to access
needed dental, vision, and hearing services than those with higher incomes.
Adults in poverty are more than three times as likely to have untreated dental
caries (tooth decay) than adults with higher incomes and are more likely to
report unmet dental needs due to cost. People of color are also less likely
than white people to get needed care — 9 percent of Black people and 12 percent
of American Indians and Alaska Natives reported having no natural teeth,
compared with less than 7 percent of white people.
Ensuring that Medicaid as well as Medicare enrollees can access
these benefits could reduce disparities in access to care and prevent more
serious health problems and the need for invasive, costly care later in life.
Medicare and Medicaid Coverage of Dental,
Vision, and Hearing Benefits Is Very Limited
Most Medicare beneficiaries lack coverage for dental, vision,
and hearing services, even for conditions that are associated with or could
lead to other significant health conditions. In many states, adult enrollees in
Medicaid have only limited coverage or none at all.
Medicare
Traditional Medicare provides only limited dental, vision, and
hearing coverage. Most Medicare Advantage (MA) plans cover some of these
services, although data on the extent of this coverage are limited. A recent analysis
suggests that MA enrollees with coverage still pay a high proportion of the
cost of these services out of pocket (65 percent of vision, 76 percent of
dental, and 79 percent of hearing costs).[2]
Dental and Oral Health Care. The Social Security Act explicitly excludes coverage under
traditional Medicare for most dental services, defined as “services in
connection with the care, treatment, filling, removal, or replacement of teeth
or structures directly supporting teeth.”[3] Another
section of the law provides coverage for services “furnished as an incident to
a physician’s professional services.”[4] Medicare
also covers “medically necessary” dental care, although the Centers for
Medicare & Medicaid Services (CMS) currently interprets this category very
narrowly.[5]
About three-quarters of MA enrollees — amounting to a quarter of
all Medicare beneficiaries — have access to some dental coverage as a
supplemental benefit under their MA plan.[6] Of
those with dental benefits, one-third have coverage only for preventive
services, such as examinations, cleanings, and X-rays. Two-thirds have more
extensive coverage. These dental benefits frequently come with additional
premiums, cost sharing, and limits on the amount of coverage.[7]
In addition, some 11 percent of Medicare beneficiaries have
dental coverage from Medicaid, or MA and Medicaid, and 8 percent have coverage
from private plans, including employer-sponsored retiree health plans and
individually purchased plans. In many cases, however, this coverage is subject
to dollar caps or other limitations. Overall, the majority of people on
Medicare have no dental coverage.[8]
Hearing Care and Audiology Services. Traditional Medicare excludes coverage for
“hearing aids or examinations therefore.”[9] However,
it covers a “hearing and balance exam” if needed to diagnose another health
condition, such as dizziness. Nearly three-quarters of Medicare Advantage
enrollees are in plans that provide some benefit for hearing aids.[10] However,
typical MA plans that provide some coverage for hearing aids pay between $800
and $1,000 every three years, which only covers half the cost of the cheapest
available option.[11]
Vision Care and Eyeglasses. Traditional Medicare does not cover eyeglasses except after
cataract surgery, examinations for prescribing or fitting eyeglasses, or
refractive examinations.[12] It
does cover eye care related to illness or injury of the eye, including cataract
surgery, glaucoma screening, eye examinations for persons with diabetes, and
certain tests and treatments for age-related macular degeneration.[13] Almost
four-fifths of MA enrollees have access to eye exams or glasses.[14]
Medicaid
States are not required to offer dental, vision, or hearing
services to adult Medicaid enrollees.[15] Even
in states that offer some coverage, enrollees’ access to care is inconsistent:
the scope of the benefits varies widely between states, and states often cut
these benefits when facing budget shortfalls.[16]
Dental and Oral Health Care. Most states provide coverage for some dental services.[17] A
2018 survey of states found that at least 38 states and Washington, D.C. offer
some dental coverage, but many states offer only emergency care.[18] (See
Figure 1.) And many states that offer some non-emergency dental coverage also
restrict access to the benefit by requiring co-payments, limiting the dollar
amount of expenditures an enrollee can receive to around $1,000 in services per
year, or excluding coverage of preventive care or other specific types of
services. Some states offer pregnant women or adults with disabilities a more
robust dental benefit than other adults.[19] And
some states limit dental and other optional benefits to enrollees who pay
premiums or engage in other behaviors.[20]
FIGURE 1
Hearing Care and Audiology Services. Medicaid coverage for hearing services is
also inconsistent across states. At least 28 states offered some hearing
services in 2015, but many have significant limits; for example, Maine covered
one set of hearing aids but only once every five years.[21]
Vision Care and Eyeglasses. Similarly, Medicaid coverage of vision services varies widely
between states. In 2018, at least 33 states offered some vision coverage, but
many of those states significantly limited coverage. For example, Idaho covers
glasses only after cataract surgery or to treat a condition that would result
in permanent eye damage, and Indiana covers glasses but only one set every five
years.[22]
States’ decisions to cover optional benefits also frequently
change based on the state’s fiscal outlook. Between 2009 and 2013, when many states
faced budget shortfalls, 27 states made cuts to dental benefits, and 17 states
cut vision benefits.[23]
Lack of Access to Dental, Vision, and Hearing
Benefits Affects Enrollees’ Health
Untreated oral health problems or hearing or vision loss can
pose serious risks for overall health. Absence of routine dental care can delay
diagnosis of some serious health conditions — such as HIV and certain
infections and cancers — and thereby lead to complications and more costly
treatments later. Untreated cavities and gum disease can result in infections,
tooth loss, and chronic pain. Lack of teeth, in turn, makes eating difficult,
reduces quality of life in other ways, and often causes poor nutrition and
related health problems. Gum disease is associated with increased risk of heart
disease and stroke, higher mortality for those with kidney disease, higher risk
of cancer, and more difficult diabetes management.[24]
Individuals with a range of chronic conditions are more
susceptible to oral disease, which can contribute to complications from these
chronic conditions and exacerbate their symptoms, including diabetes and
respiratory conditions. Untreated periodontal disease in pregnant people may
also affect pregnancy outcomes.[25]
Untreated hearing or vision loss in older adults can lead to a
variety of physical and mental health problems.[26] Hearing
loss increases the risk of dementia, falls, and depression and may increase
social isolation and reduce cognitive function. Nevertheless, few people with
hearing loss use a hearing aid, often because of the cost.[27] Poor
vision is associated with an increased risk of falls, depression, cognitive
impairment, hospitalization, and limited mobility.[28]
There is also direct evidence that lack of dental coverage in
Medicaid leads to additional emergency department visits. States’ dental
benefit cuts are associated with an increase in emergency department visits due
to untreated dental issues, studies have shown. For example, when California
eliminated its comprehensive dental benefit in 2009, emergency department
visits for dental problems among Medicaid enrollees substantially increased. By
monitoring adults aged 21 and over with Medicaid coverage between 2006 and
2011, one study found that the rate of emergency department visits for dental
conditions rose by 32 percent (from a monthly average rate of 42 visits to 56
visits per 100,000 adults). The policy change had a racially disparate effect —
while it affected all racial and ethnic groups, the effects were most clear
among Black and Hispanic adults.[29]
Similarly, Oregon cut dental coverage in 2003, along with several
other benefit changes for a subset of adult Medicaid enrollees. Researchers
surveyed members over time who had lost their dental benefits and compared the
use of care between members who had lost dental benefits and those who had not.
This research found that adults who lost dental benefits were significantly
more likely to use the emergency department for dental problems compared with
those who still had dental coverage. Those who lost benefits were nearly three
times as likely to report having unmet dental needs as those who retained their
benefits, and only one-third as likely to get routine dental care.[30]
Low-Income Adults and People of Color More
Likely to Have Unmet Needs for Dental Care
Low-income adults are particularly likely to suffer the effects
of poor access to dental care.[31] (See
Figure 2.) Adults in poverty are more than three times as likely to have
untreated dental caries (tooth decay) than adults with incomes above 400
percent of the federal poverty level.[32] Between
2005 and 2008, 42 percent of non-elderly adults with incomes below the poverty
line ($17,600 per year for a family of three in 2008) had untreated dental
caries, compared to just 11 percent for those with incomes above 400 percent of
poverty (about $70,400 for a family of three). Poor oral health among young
adults can also lead to more significant dental problems as they age. Among
adults aged 65 and older, 37 percent of those in poverty had complete tooth
loss, compared to just 16 percent of those with incomes at or above 200 percent
of the poverty line.[33]
FIGURE 2
There are also significant racial disparities among people
reporting trouble with vision or hearing and those who have lost all of their
natural teeth. Nine percent of Black people and 12 percent of American Indians
and Alaska Natives reported having no natural teeth, compared with less than 7
percent of white people. (See Figure 3.)[34]
FIGURE 3
Congress Should Ensure That All Medicare
and Medicaid Enrollees Have Access to Dental, Vision, and Hearing Benefits
If Congress considers legislation to expand coverage for dental,
vision, and hearing benefits in Medicare — as it should — it should also
require states to offer these critical services to low-income non-elderly
adults with Medicaid coverage. Failing to do so would leave out a group even
more likely to have unmet needs for dental care due to cost than Medicare
enrollees.
Congress Should Expand Medicare’s Dental, Vision, and Hearing
Benefits
Analysts have identified a range of options for expanding
dental, hearing, and vision coverage under Medicare.[35] The
most straightforward and comprehensive approach for beneficiaries would be to
add these benefits to Part B of Medicare. Another would create a new voluntary
benefit under a separate part of Medicare, similar to the prescription drug
benefit under Part D.[36] Each
of these approaches would require decisions about covered benefits, cost
sharing, premiums, payment rates, provider participation, and assistance for
low-income beneficiaries. Other more limited options include broadening the
coverage of medically necessary dental care, testing alternative models of coverage
under the CMS demonstration authority, and offering discount cards or other
cash assistance to help cover the cost of services.
H.R. 3, which the House passed in December 2019, would add
comprehensive dental, hearing, and vision coverage to Part B of Medicare.[37] Its
dental and oral health benefit would cover preventive services, including
examinations, cleanings, and X-rays; basic treatments, such as tooth
restorations, extractions, and periodontal treatment; major treatments, such as
bridges, crowns, and root canals; and one set of dentures every five years. The
Secretary of Health and Human Services would determine which basic and major
treatments would be covered. Medicare would pay 80 percent of the cost of oral
health services other than major treatments starting in 2025. It would pay 10
percent of the cost of major treatments in 2025, gradually rising to 50 percent
in 2030 and thereafter.[38]
The hearing benefit in H.R. 3 would cover aural rehabilitation
services and one set of hearing aids every five years for people with profound
or severe hearing loss starting in 2023. It would also designate audiologists
as practitioners under Medicare. The vision benefit would cover routine eye
examinations and contact lens fitting services, but no more than once every two
years, starting in 2023. It would cover eyeglasses and contact lenses starting
in 2024, up to $85 for frames and $85 for eyeglass lenses once every two years,
and up to $85 for a two-year supply of contact lenses.
The Congressional Budget Office estimates that the additional
benefits would increase Medicare spending by $358 billion over the 2020-2029
period. Of this total, $238 billion would be for dental and oral health, $89
billion for hearing care, and $30 billion for vision care. By 2029 the total
annual cost would be $84 billion, or about $1,180 per Part B beneficiary, of
which the dental benefit would represent three-quarters. Under H.R. 3,
prescription drug savings would offset these additional costs, as well as
improvements in Medicare benefits for low-income seniors and people with
disabilities.[39]
The cost of the new dental, hearing, and vision benefits in H.R.
3 would not be included in the calculation of Part B premiums but would be
financed fully from general revenues. Policymakers could reasonably consider
including these benefits in the calculation of premiums as a way of holding
down federal costs to make room for other coverage improvements. Phasing in the
premium increase over several years could soften its impact.
Licensing All Qualified Providers Would Expand Access to Needed
Dental Care
In conjunction with improving dental benefits, Congress may also
want to consider policies that further enable skilled providers other than
dentists to offer dental services. While states are generally responsible for
licensing and defining the scope of practice of health care providers, federal
policymakers could offer incentives for states to modernize their policies and
consider federal options to allow dental therapists to provide care to Medicare
and Medicaid enrollees. Doing so could improve access to dental care while also
lowering the cost of making care widely available.
States are generally responsible for licensing and defining the
scope of practice of health care providers, including dental providers. Since
2004, 11 states have authorized midlevel dental providers, or dental
therapists, who are similar to physician assistants and are generally
authorized to provide services such as exams, dental fillings, and extractions,
though their scope of practice varies by state.a Dental therapists can operate in dentists’ offices,
freeing dentists to provide more complex care, or they can provide needed care
in community settings, such as schools or nursing homes.b
More than 58 million people in the United States live in areas
with shortages of dental care providers. Widespread use of dental therapists
could significantly expand access to care, and dental therapy can provide a
career pathway for people from underserved areas to provided needed services to
their communities.
aAllison Corr, “What Are Dental Therapists?” Pew Charitable
Trusts, October 9, 2019, https://www.pewtrusts.org/en/research-and-analysis/articles/2019/10/09/what-are-dental-therapists.
bIbid.
Medicaid Enrollees Need Access to Dental, Vision, and Hearing
Services
Fixing gaps in coverage only in Medicare without making the
corresponding changes in Medicaid would exclude many people with significant
unmet needs. Providing access to a full range of preventive services and
treatment for non-elderly adults with Medicaid coverage could prevent more
serious conditions later in life as well as the need for more invasive, costly
procedures.[40]
As shown in Figure 4, while a significant share (about 11
percent) of traditional Medicare enrollees aged 65 and over report having unmet
dental needs due to cost, the share is almost two-thirds higher (over 18
percent) among Medicaid enrollees under age 65, who are low income by
definition. While Medicaid enrollees under the age of 21 are eligible for
dental care as part of the Early and Periodic Screening, Diagnostic, and
Treatment benefit, once young adults turn 21, many no longer have access to
treatment options. Adult Medicare beneficiaries under age 65 with disabilities
— many of whom also receive Medicaid — face disproportionate challenges in
obtaining needed dental care.[41] Low-income
seniors enrolled in both Medicare and Medicaid also have higher rates of unmet
dental needs due to cost than other Medicare enrollees.[42]
People with Medicaid coverage are also substantially more likely
to report hearing, vision, and dental problems than people with private
insurance. Those who are dually eligible for Medicare and Medicaid — primarily
low-income seniors — are substantially more likely than other Medicare enrollees
to face vision and dental problems.
Congress would need to make various design decisions in adding
dental, vision, and hearing benefits to Medicaid. They include: how the federal
government and states would share the cost; what benefit standards the federal
government would set; and whether Congress would permit nominal cost sharing.
No official estimate of the cost of adding comprehensive dental,
hearing, and vision benefits to Medicaid, in addition to Medicare, is available,
but it might be half or less than that of adding this coverage to Medicare
alone, depending in part on these design choices. For one, fewer enrollees
would get the benefits than under Medicare: the number of adult Medicaid
beneficiaries who are not receiving Medicare (the population who would be
eligible for a new mandatory dental benefit in Medicaid) is only about half the
number of Medicare Part B beneficiaries. Also, utilization of dental, hearing,
and vision services is somewhat lower among working-age adults than among
seniors and persons with disabilities. And as noted above, access to preventive
care is associated with a reduction in utilization of the emergency department
for dental services, which would likely offset a share of the cost of the new
benefit. In addition, some states already cover some of these services, and
states would likely share some of the cost of the new Medicaid benefits,
depending on the federal matching rates and maintenance-of-effort requirements.
Unlike Medicare, however, Medicaid has little or no cost sharing (because its
enrollees are low-income), which would add to the federal cost.
FIGURE 4
End Notes
[1] CBPP analysis of Congressional Budget
Office’s March 2020 Medicare and Medicaid baseline estimates and 2018 Centers
for Medicare & Medicaid Services (CMS) Program Statistics data.
[2] Amber Willink et al.,
“Dental, Vision, and Hearing Services: Access, Spending, and Coverage for
Medicare Beneficiaries,” Health Affairs, February 2020, p.
302, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.00451.
[3] Social Security Act, section
1862(a)(12).
[4] Social Security Act, section
1861(s)(2)(A).
[5] W. Kwok, Coverage for Medically
Necessary Oral Care Is Unduly Restricted by Medicare’s Dental Policy,
Center for Medicare Advocacy, March 2, 2017, https://medicareadvocacy.org/medically-necessary-oral-health-care-is-coverable-under-current-medicare-law/.
[6] Meredith Freed, Anthony Damico, and
Tricia Neuman, A Dozen Facts About Medicare Advantage in 2020,
Kaiser Family Foundation, April 22, 2020, https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2020/.
[7] Meredith Freed, Tricia Neuman, and
Gretchen Jacobson, Drilling Down on Dental Coverage and Costs for
Medicare Beneficiaries, Kaiser Family Foundation, March 13, 2019, https://www.kff.org/medicare/issue-brief/drilling-down-on-dental-coverage-and-costs-for-medicare-beneficiaries/.
Data for 2016.
[8] Ibid.
[9] Social Security Act, section 1862(a)(7).
[10] Freed, Damico, and Neuman, op.
cit.
[11] Amber Willink, Cathy Schoen, and Karen
Davis, How Medicare Could Provide Dental, Hearing, and Vision Care for
Beneficiaries, Commonwealth Fund, January 18, 2018, https://www.commonwealthfund.org/publications/issue-briefs/2018/jan/how-medicare-could-provide-dental-vision-and-hearing-care.
[12] Social Security Act, section 1682(a)(7).
[13] CMS, MLN Fact Sheet: Medicare
Vision Services, April 2018, https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/visionservices_factsheet_icn907165.pdf.
[14] Freed, Damico, and Neuman, op.
cit.
[15] The Early and Periodic Screening,
Diagnostic, and Treatment benefit requires states to provide comprehensive
dental, vision, and hearing services to children and young adults enrolled in
Medicaid under age 21.
[16] Kaiser Family Foundation, “States Focus
on Quality and Outcomes Amid Waiver Changes: Results from a 50-State Survey,”
October 2018, http://files.kff.org/attachment/Report-States-Focus-on-Quality-and-Outcomes-Amid-Waiver-Changes-Results-from-a-50-State-Medicaid-Budget-Survey-for-State-Fiscal-Years-2018-and-2019.
[17] Federal Medicaid regulations define
dental services as “diagnostic, preventive, or corrective procedures provided
by or under the supervision of a dentist in the practice of his profession,
including the treatment of – (1) the teeth and associated structures of the
oral cavity; and (2) disease, injury, or impairment that may affect the oral or
general health of the recipient.” (42 CFR 440.100.)
[18] Kaiser Family Foundation, “Medicaid
Benefits: Dental Services,” 2018, https://www.kff.org/medicaid/state-indicator/dental-services/.
[19] Medicaid and CHIP Payment and Access Commission
(MACPAC), “Medicaid Coverage of Dental Benefits for Adults,” June 2015, https://www.macpac.gov/wp-content/uploads/2015/06/Medicaid-Coverage-of-Dental-Benefits-for-Adults.pdf.
[20] Judith Solomon, “Kentucky Waiver Will
Harm Medicaid Beneficiaries,” Center on Budget and Policy Priorities, January
16, 2018, https://www.cbpp.org/research/health/kentucky-waiver-will-harm-medicaid-beneficiaries; see
also CMS, “CMS Approves Nebraska Medicaid Demonstration to Provide
Pathway to Enhanced Benefits for Eligible Adults,” October 20, 2020, https://www.cms.gov/newsroom/press-releases/cms-approves-nebraska-medicaid-demonstration-provide-pathway-enhanced-benefits-eligible-adults.
[21] Kaiser Family Foundation, “Medicaid
Benefits: Hearing Aids and Other Hearing Devices,” 2018, https://www.kff.org/medicaid/state-indicator/hearing-aids.
[22] Kaiser Family Foundation, “Medicaid
Benefits: Eyeglasses and Other Visual Aids,” 2018, https://www.kff.org/medicaid/state-indicator/eyeglasses/.
[23] Kaiser Family Foundation, 50-State
Medicaid Budget Survey Archives, 2008-2009, 2010-2011, 2012-2013, https://www.kff.org/medicaid/report/medicaid-budget-survey-archives/.
[24] Freed, Neuman, and Jacobson, op.
cit.
[25] Bruce Dye et al., “Selected
Oral Health Indicators in the United States, 2005-2008,” Centers for Disease
Control and Prevention (CDC), National Center for Health Statistics, May
2012, https://www.cdc.gov/nchs/data/databriefs/db96.pdf.
[26] World Health Organization, “World Report
on Vision,” 2019, https://www.who.int/publications/i/item/world-report-on-vision.
[27] Center for Medicare Advocacy, “Medicare
Coverage of Hearing Care and Audiology Services,” n.d., https://medicareadvocacy.org/medicare-info/medicare-coverage-of-hearing-care-and-audiology-services/.
[28] Willink et al, op. cit.
[29] Astha Singhal et al.,
“Eliminating Medicaid Adult Dental Coverage in California Led to Increased
Dental Emergency Visits and Associated Costs,” Health Affairs, May
2015, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2014.1358.
[30] Neal T. Wallace et al., “The
Individual and Program Impacts of Eliminating Medicaid Dental Benefits in the
Oregon Health Plan,” American Journal of Public Health, November
2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222412/.
[31] MACPAC 2015, op. cit.
[32] Kaiser Commission on Medicaid and the
Uninsured, “Oral health and Low-Income Nonelderly Adults: A Review of Coverage
and Access,” June 2012, https://www.kff.org/wp-content/uploads/2013/03/7798-02.pdf.
[33] Dye et al., op. cit.
[34] Summary Health Statistics: National
Health Interview Survey, 2016, Table A-6a, https://www.cdc.gov/nchs/nhis/shs/tables.htm.
Data are age-adjusted.
[35] Meredith Freed et al., Policy
Options for Improving Dental Coverage for People on Medicare, Kaiser Family
Foundation, September 18, 2019, https://www.kff.org/medicare/issue-brief/policy-options-for-improving-dental-coverage-for-people-on-medicare/.
[36] Willink, Schoen, and Davis, op.
cit.
[37] H.R. 3, 116th Congress, The Elijah E.
Cummings Lower Drug Costs Now Act, Title VI, https://www.congress.gov/bill/116th-congress/house-bill/3.
[38] For suggested improvements in the
Medicare oral health benefit, see Shawn Greminger and Cheryl
Fish-Parcham, Medicare Oral Health Benefit Passed by the House of
Representatives Sets Bold Precedent but Should Be Strengthened to Best Serve
Low- and Moderate-Income Enrollees, Families USA, February 2020, https://familiesusa.org/wp-content/uploads/2020/02/OH_Importance-of-Oral-Coverage_IssueBrief.pdf.
[39] Congressional Budget Office, Letter to
the Honorable Frank Pallone Jr., “Budgetary Effects of H.R. 3, the Elijah E.
Cummings Lower Drug Costs Now Act,” December 10, 2019, https://www.cbo.gov/system/files/2019-12/hr3_complete.pdf.
Note that, because fiscal year 2029 begins on a weekend, there are only 11
payments to Medicare Advantage plans that year. Also, the dental benefit in
H.R. 3 is not fully phased in until 2030.
[40] United States Department of Health and
Human Services, “Oral Health in America: A Report of the Surgeon General,”
2000, https://www.nidcr.nih.gov/sites/default/files/2017-10/hck1ocv.%40www.surgeon.fullrpt.pdf.
[41] Amber Christ and Jennifer
Goldberg, Adding a Dental Benefit to Medicare: Addressing Oral Health
Inequity Based on Disability, Justice in Aging, October 2020.
[42] Summary Health Statistics: National Health
Interview Survey, 2016, Table A-19a, https://www.cdc.gov/nchs/nhis/shs/tables.htm.
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