Countless Americans are returning to the dentist after delaying care during the pandemic. But even before COVID-19 caused millions to delay their oral health care, challenges finding affordable and appropriate dental care were the norm for many Californians with low incomes.
High costs, lack of clarity over which benefits are covered and limited providers, especially ones that reflect the diversity of the communities they serve, have forced historically excluded communities to delay or completely forgo oral health care. Delayed care often leads to excruciating pain only a costly emergency room visit can fix, leaving people with thousands of dollars of medical debt.
Oral health is an essential, yet often overlooked, component of overall health. Poor oral health is linked to higher rates of diabetes and heart disease and has also been linked to more severe cases of COVID-19. Poor oral health can also limit employment opportunities and ongoing dental issues can lead to job loss when workers are forced to miss work due to oral pain.
In our findings, communities of color across California reported confusion over dental benefits, stigmatizing treatment from dental providers, lack of culturally and linguistically competent providers and high cost of care, as barriers they face to treatment. Others reported having to travel for hours to find an oral health provider that accepts Medi-Cal.
California has changed the scope of Medi-Cal adult dental benefits three times in the past decade, causing confusion and variability in the program. Adult dental benefits are often on the chopping block when the state faces economic downturns, leading to uncertainty among consumers and providers alike. Other states are not so lucky in that adult dental care is completely excluded from their state’s Medicaid program. Even after California reinstated benefits, access rates have not returned to previous levels.
Oral health care should not be a luxury afforded to the wealthy or those with the time to navigate a complex web of administrative red-tape. When stacked against other urgent needs like putting food on the table for your family or paying rent to keep a roof over your head, it is no surprise that people already struggling to make ends meet would delay dental care. When states treat oral health as a budget fix, the damage to people’s physical, oral and economic health is irreparable.
Members of communities of color and rural communities as well as people with disabilities, low incomes and advanced age are the individuals most likely to go without dental care today. They face a stark lack of affordable options in an already fragmented medical system that treats oral health as optional or ancillary to overall health. These communities value the importance of oral health but face numerous external and systemic barriers to care.
Recent federal legislation introduced by U.S. Rep. Nanette Barragán, D-Calif., seeks to advance racial and health equity by protecting the oral health of all Americans. The Medicaid Adult Dental Benefit Act would make comprehensive adult dental coverage a permanent fixture under all Medicaid programs. Instead of the current state-by-state patchwork of oral health benefits, millions of people on Medicaid would be able to access preventative, restorative, and urgent oral health services free of cost.
An important aspect of this legislation would require timely collection and disaggregation of important data that advocates have long sought. For example, several metrics would measure the use of procedures designed to treat tooth decay across race, ethnicity, age, sexual orientation, gender identity, geographic location and more. This information will help states and advocates identify disparities and hold states accountable for addressing them. The bill also requires states to initiate targeted outreach and education campaigns to ensure all residents recognize and access these critical services.
This important and urgent federal legislation is a first step, but we must not stop there. The next step after providing comprehensive coverage is educating our communities about their guaranteed benefits to ensure they can utilize services comfortably and receive culturally and linguistically competent care. Advancing oral health equity is a racial and economic justice imperative and will put us on a path toward better health outcomes.
Kiran Savage-Sangwan is the executive director of the California Pan-Ethnic Health Network, a statewide health advocacy organization focused on addressing racial and ethnic health disparities.
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