Regional News

Health Care Authority working to restore adult dental benefit in Medicaid


Oct 11, 2013

Washington State’s Health Care Authority is rebuilding the guidelines and treatment codes for dentists and doctors so the Apple Health/Medicaid program can restore the adult dental benefit that was cut back to emergency-only coverage during the state’s fiscal crisis.

“Health care advocates worked hard all session long to restore this benefit, and the upshot was both House and Senate budgets ultimately reflected the need for full dental services regardless of age,” said Dorothy Teeter, Director of the Health Care Authority. “Although the cut did not affect our children’s coverage or most pregnant women, it was a major hardship for our elderly adults and many people with disabilities.”

“Medicine today is realizing that dental care is one of the essentials – a preventive service that provides early warning of physical problems as well as therapies that can maintain and restore good health in many cases,” said State Medicaid Director MaryAnne Lindeblad. “Gum disease is strongly linked to conditions like diabetes, heart disease, stroke, pneumonia and pregnancy problems.”

During the cut, clients could only receive dental services like extraction or temporary relief of pain or infection or treatment of trauma-caused damage. Because those services are often not available in hospital emergency rooms, some clients were never referred on to dental surgeons and even treatable injuries were sometimes not addressed as effectively as possible.

The new benefit covers restorative and preventative services, resin partials and complete dentures, root canals, cavities, and routine checkups and cleanings, as well as emergency services.

The Medicaid program began notifying dentists this month that the benefit would be restored on January 1, 2014, and that offices and clinics could start making appointments with Medicaid clients after that date.

The benefit is also available to Apple Health/Medicaid clients who enroll under higher-income eligibility rules that go into effect on January 1.

Health care professions say that routine dental care is an essential part of good health.

  • Checkups often find dental problems early when they are easier to treat and more likely to be reversed.
  • People with diabetes and gum disease will have more difficulty controlling their blood sugar levels, which can lead to blindness, amputation and kidney disease.
  • Pregnant women should visit the dentist throughout their pregnancy and have dental problems treated before their babies are born. Germs that cause cavities can be spread from parents to children through saliva.
  • Above all, don’t wait until you are in pain to see a dentist. Visit the dentist or dental clinic for regular checkups.

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