News + Issues

Medicaid’s exclusion of patients with special needs

Patients at the Arizona School of Dentistry & Oral Health. Photography by Mark Skalny.
Patients at the Arizona School of Dentistry & Oral Health. Photography by Mark Skalny.

Imagine for a minute that you have an adult family member who has a neurodevelopmental disorder, such as autism, or an intellectual disability (ND/ID). This individual with special needs must see a dentist to alleviate pain or treat oral disease but you cannot afford care and don’t qualify for Medicaid. What do you do now? How long will your loved one have to suffer?

Now come back to reality. You are a dental student who has the ability to learn, provide care and advocate for patients with special needs. Currently, those with an intellectual disability are the most underserved medical and dental population (MUP). Volumes of documentation support this evidence with access to dental care as the number one health problem people with disabilities face.

The U.S. Department of Health and Human services maintains a formula for distinguishing w MUPs. When calculated for people with ND/ID, the formula proves that this population is deserving of the distinction and the medical and dental resources that follow (read more on this argument in this journal article published in Special Care in Dentistry and this press release from the American Academy of Developmental Medicine and Dentistry). You can read about the MUP formula here: HRSA MUP Formula

Dental coverage offered to adult individuals with ND/ID through Medicaid varies within each state because dental services are not a federally mandated benefit for adults (visit Medicaid Mandatory Benefits).  There are few states that provide Medicaid Adult Benefits for dentistry and may only provide emergency services (extraction). Most states do not carve out the ND/ID population in this coverage, most of who live at the poverty level, which is demonstrated in this Global Report.  According to the Centers for Disease Control and Prevention, 13.87% of US individuals between the ages of 3-17 have a disability and may be forced to live with dental pain that is often demonstrated by behavioral issues. Since individuals with ND/ID often have limitations in communicating, their dental pain can go unnoticed by caregivers. If the individual was provided access to comprehensive dental care, including regular examinations, oral health problems could be treated and avoided.

If the federal government provides individuals with ND/ID the designation of MUP it will enable more dentists to provide comprehensive dental care for this population by offering tuition loan reimbursement programs and incentivized research opportunities. Patients with ID/ND will also have more access to dental care with the development of special Medicaid rates (HRSA Medically Underserved Populations ). These changes would allow individuals with ND/ID to have regular dental care and a higher quality of life.

In March 2011, the American Medical Association reacted to this issue by passing a resolution to declare people with an intellectual disability “a medically underserved population.”  In November 2013, the American Dental Association was presented with a similar resolution and voted to refer it to the Council on Access, Prevention and Interprofessional Relations (CAPIR) for further evaluation.

I believe that individuals with ND/ID need our support. We have the opportunity to advocate for individuals with ND/ID to be considered a MUP. You can start by learning more about individuals with ND/ID and finding out what services your school’s clinic offers to this patient population.

Screen Shot 2014-01-21 at 8.53.36 AMASDA members are dedicated to patients with special needs and focused an issue of Mouth on this patient population. Click here to read the 2012 winter issue of Mouth.



~Sarah Rose Usher, MPH, Arizona ’14

Sarah Usher

Sarah Rose Usher is a dental student at ASDOH in Arizona graduating in 2014. She has served as activities chair and Treasurer in the ASDOH ASDA chapter. She enjoys local and international community service outreach projects and advocating for health care opportunities for patients with special needs.

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  1. Thanks for this great article, yes access to dental care to prevent pain and psychological distress and poor nutrition is surely a human right. People with disabilities require proper quaility services which address their special needs and should not have to rely on ad hoc charity and goodwill.
    It is up to motivated young students ourself to become involved and advocate for all members of the society in which you will work and lobby for access to care with all the effort that you and your peers can muster. Good luck with achieving change in your state.

  2. Sarah Usher says:

    Thank you for your supportive comments Alison. The advocacy team for patients with special needs is strengthening each day! All ASDA members are encouraged to learn more and vote YES on the “Medically Underserved” Resolution that will be presented at the 2014 ASDA Annual Session.

  3. Stephen B. Corbin says:

    Congratulations on a well articulated argument, both scientific and humanitarian, as to why it is essential that no population be neglected in terms of critical oral health care. American dentists are highly skilled individuals, committed to their patients. Advocating for a medically underserved designation (for all health care, including oral health care) for people with developmental disabilities is a logical stance for organized dentistry to adopt and advocate for.

    1. Sarah Usher says:

      Dr. Corbin,
      Thank you for your review and comments regarding this article. I am looking forward to the time in my career when all patients have an opportunity to receive superior healthcare including oral health care. Not only do we need the support of our leaders organized dentistry, but also the support of our public health colleagues. This is a team effort and our collaboration will yield true success.
      Thank you.

  4. A well-crafted argument with a great foundation in what it means to be a caregiver. Wishing you much success in your mission and as a future provider.

    1. Sarah Usher says:

      Rich – You recognized the unique character that each of us own as a health care provider. I appreciate your comments and am excited to develop my knowledge and skills and have the opportunity to further my advocacy and care for the ND/ID population.

  5. Michael says:

    Than you so much Dr. Usher for making us aware of this very important need
    for this underserved group of individuals in our society. Hopefully the powers that
    be will recognize this and take action. It is very refreshing to know that our new student dentists are so concerned about this often neglected group of individuals.
    Good luck and may God bless !

    1. Sarah Usher says:

      Thank you for your support Michael. If you would like to learn more about the advocacy that takes place within the American Academy of Developmental Medicine & Dentistry (AADMD) please visit this website:

      I look forward to hearing of your ideas on how we can further advocate for the ND/ID population.

  6. Cary Kelly says:

    Thank you so much for your efforts to make this an issue to be addressed. As the father of a son with Downs Syndrome, I can attest to the facts you raise (he’s 35 years old, I adopted him from an institution when he was 4). Our first obstacle was finding a dentist willing to treat Christopher. Then willing to accept Medicaid. Then Medicaid was unwilling to pay for intravenous sedation. After years of receiving sporadic care, I finally had to make the heart wrenching decision to have his teeth removed. Under the circumstances this was my only option at the time to rid him of the obvious pain he was enduring. He is non-verbal, and the poor guy was unable to articulate what he was experiencing. He has learned to adapt without teeth very well and is a happy camper. But I’ll always wonder, what if…
    I am in my 30th year of providing supports for people with developmental disabilities in residential, employment, and day program settings. This is an overwhelming issue for the majority of people I support. Thanks again, and keep up the good work.

    1. Sarah Usher says:

      Thank you for sharing your story and for the selfless actions you take each day to create a healthy and happy life for your son and others with developmental disabilities. Family and self-advocacy are important voices which encourage and support our desire for positive change!
      Thank you.

  7. This is so inspiring! I wish you a more success on your advocate in providing dental care assistance to people with special needs.

    1. Sarah Usher says:

      Thanks Speed Braces! If you would like to learn more about AADMD and our advocacy for the ND/ID population please visit this website:

      Are you currently in the dental workforce or an academic program? Are you aware of any programs in your area(city or state)/office/school that make access to care a reality for this population?

  8. This is a great and powerful article that touches everyone.

    1. Sarah Usher says:

      Theresa – Thank you for your review of this article. The ASDA resolution to gain their support for the MUP designation is currently under review and will be up for vote at the 2014 ASDA Annual Session.

  9. Thank you for writing this wonderful blog.

    1. Sarah Usher says:

      Midland Dentistry – Thank you for your comments and support. I look forward to a productive year within organized dentistry. Please let me know if you have any additional resources that can support this advocacy.

  10. Sarah,

    Thank you for bringing this issue to the attention of your fellow dental students. I know things have changed somewhat in dental school since I attended (many moons ago), but back then, people with ID/DD were truly invisible and providing dental treatment to this group was something most of us never even considered. We didn’t receive any training in providing care to patients with neurodevelopmental issues, which made providing care even more unimaginable after graduation. I was fortunate to do an general practice residency in a facility that also had a clinic for children with developmental disabilities, and that’s when I was exposed to all the issues surrounding care for these individuals. Keep getting the word out!

    1. Sarah Usher says:

      Dr. D – Your enthusiasm and knowledge inspires dental students across the country to explore the world of special care dentistry and to later incorporate special patient care into their practice. The knowledge and training is becoming widely available to us, we just need to reach out, grab it and make it our own. If we can do this as a collaborative effort: dentistry, medicine, public health, etc. our successes for the ND/ID population will be great! Looking forward to tomorrow!!

  11. Sarah Usher says:

    The American Dental Association approved MUP Resolution!

    “96. Resolved, that the American Dental Association support a simplified process across appropriate governmental agencies to designate individuals with intellectual disabilities as a medically underserved population, and be it further Resolved, that the ADA seek to collaborate with the American Medical Association and the American Academy of Developmental Medicine and Dentistry to promote this process to appropriate governmental agencies.”

    Will ASDA make the same powerful statement?

    Don’t get left behind, learn more here from the American Academy of Developmental Medicine & Dentistry:

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