Oral Health Equity: CMS Research on Medicaid and Medicare

When we think about healthcare inequality, we usually picture emergency rooms and hospital beds. But there’s another battleground in American healthcare that’s often overlooked: dental care.

The Centers for Medicare & Medicaid Services (CMS) just released data that exposes a stark reality about oral health in America. This isn’t just about cavities and cleanings – it’s about addiction recovery, pregnancy outcomes, and even Alzheimer’s progression.

What they found is both surprising and concerning. From substance use disorder patients needing specialized care to pregnant women facing barriers to treatment, the data tells a story of a system that’s leaving vulnerable populations behind.

This analysis digs into the numbers behind these disparities, examining how factors like geography, coverage policies, and demographics shape who gets care and who doesn’t. More importantly, it shows us exactly where we need to focus to fix this broken system.

Let’s dive into what CMS discovered, why it matters, and what we can do about it.

Substance Use Disorders and Dental Care Utilization

Diving into the data: People battling substance use disorders are 2.6 times MORE likely to hit up a dentist than someone without SUD. And they’re not going for routine checkups. Nope. They’re going for the hardcore stuff.

We’re talking oral surgery central. 3.6 times more likely to get sliced and diced in the mouth. But preventive care? Nada.

The state-by-state breakdown? It’s like a dental coverage roulette. Some states are throwing down Medicaid dental coverage like free drinks at a casino, while others are basically telling people to DIY their dental work.

Covid-19 and Endodontic Services

Enter COVID-19 – the pandemic that basically crashed every healthcare party. But root canals? They were the unexpected survivors of this medical mayhem.

While everything else was shutting down, endodontic services were holding steady like that one friend who never panics during a crisis.

Root canal treatments didn’t just survive – they basically shrugged off the pandemic. But not everyone got equal access to this dental dental lifeline.

The geography of root canals looks like a tale of two cities. Rural residents? Limited options. Urban dwellers? Root canal central. Some states were handing out endodontic coverage like free samples, while others treated root canals like a luxury item.

Bottom line: Even a global pandemic couldn’t totally crush dental care. But it exposed the cracks in a system that’s been broken long before COVID came to town.

Dental Care During Pregnancy

Pregnancy: where your body becomes a construction zone, and apparently, dental care becomes an afterthought.

Out of every 1,000 pregnant Medicaid beneficiaries, only 137 managed to get any dental services. Let that sink in. For every thousand expectant mothers, 863 are giving their oral health the silent treatment.

The numbers get even more stark. A mere 89 per 1,000 received an oral evaluation. Emergency dental visits? Rare as a quiet toddler, landing at just 10 per 1,000.

Age and ethnicity played a massive role in who gets dental care. Older pregnant women (35-44) were more proactive than younger women. American Indian/Alaskan Native and Asian/Pacific Islander women were leading the pack in dental visits, while other racial groups lagged behind.

The state-level data tells a predictable story: More comprehensive Medicaid dental coverage equals more dental visits.

Oral Health and Alzheimer’s Disease in Nursing Homes

CMS dug into the data of 2.4 million nursing home residents, and what they found was eye-opening. For every 1,000 residents, 359 were battling Alzheimer’s. The numbers climb higher with age, maxing out in the 85+ crowd.

These patients are dealing with a triple threat:

• Complete tooth loss
• Inflamed gums
• Mouth pain

The science is starting to connect some scary dots. That hippocampus in your brain? The memory control center? Turns out losing your teeth might be shrinking it.

Translation: Your dental health isn’t just about a pretty smile. It might be your brain’s best defense against cognitive decline.

Key Drivers of Disparities in Dental Care Utilization

Let’s break down what’s really driving these dental care gaps. The data shows four major factors that keep showing up.

First up: State Medicaid Coverage. States that actually invest in dental coverage see nearly double the utilization rates. When pregnant women in generous states are twice as likely to get their teeth checked as those in stingy states, we’re not talking about small differences anymore.

Geography plays its part too. Living in a city? Dental offices everywhere. Rural area? Good luck finding a dentist within 50 miles. It’s like dental care takes a road trip.

The demographic breakdown tells an uncomfortable truth. Older adults are more likely to get dental care than younger ones (maybe wisdom does come with age). Meanwhile, American Indian/Alaskan Native patients consistently show up for dental care more than others, while Non-Hispanic Black patients face the steepest uphill battle.

Then there’s the chronic conditions crew – people dealing with substance use or Alzheimer’s.

Policy Implications and Recommendations

So what do we actually do about all this? Here’s the reality check our healthcare system needs:

First – states need to stop treating dental care like it’s optional. The data’s crystal clear: better Medicaid dental coverage = better outcomes.

Second, we need to stop treating the mouth like it’s disconnected from the rest of the body. Want to help someone recover from addiction? Check their teeth. Caring for a pregnant woman? Include dental care. Working with Alzheimer’s patients? Don’t forget about oral health.

Rural areas need serious attention. Tele-dentistry isn’t just a COVID trend – it’s a lifeline. And mobile clinics? They’re not just nice to have, they’re necessary.

We also need dentists who know how to handle complex cases. Your average dental school grad might not be ready to treat someone battling addiction or managing Alzheimer’s. That needs to change.

Finally, let’s talk about awareness. The stigma around dental care during pregnancy or substance use recovery needs to go. These aren’t luxury services – they’re essential health care.

Conclusion

Your mouth isn’t just about having a nice smile for Instagram. It’s ground zero for your entire health system. And right now? That system is failing the people who need it most.

We’ve seen the numbers. People fighting addiction, expecting mothers, seniors battling Alzheimer’s – they’re all getting caught in a web of inadequate coverage, limited access, and outdated thinking.

This isn’t just about teeth. It’s about dignity. It’s about equality. And it’s about time we did something about it.