Report Calls for Congress to Add Oral Health and Other Key Coverage to Medicare and Medicaid

A recent Center on Budget and Policy Priorities (CBPP) report Medicaid and Medicare Enrollees Need Dental, Vision, and Hearing Benefits highlights the need for dental, vision, and hearing benefits in the two programs, and calls on Congress to fill these gaps in coverage.

As the Center for Medicare Advocacy has detailed in previous CMA Alerts and advocacy, Medicare does not currently provide comprehensive coverage for oral health, or for vision or hearing. The CBPP report cites this gap in Medicare coverage, while also highlighting the limited benefit in Medicaid. “States are not required to offer dental, vision, or hearing services to adult Medicaid enrollees. . . . the scope of the benefits varies widely between states, and states often cut these benefits when facing budget shortfalls.”

Serious health consequences can arise from untreated dental, vision and hearing needs in both populations. Lack of coverage can lead to delays in necessary treatment, often resulting in more expensive treatment at a later time, decreased quality of life, additional emergency department visits, complications for other chronic conditions and harm to overall health.

In calling for Congressional action, the Report also cited disparities in care, with statistics demonstrating that low-income adults and people of color were more likely to have poor access to care and increased unmet needs, such as untreated cavities. “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.”

The Report emphasized that only expanding coverage in Medicare would be insufficient to meet the vast need for such services among vulnerable adults. “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.