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.gov: 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.
ASDA 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