As dental students, we have a lot going on and, as you may have noticed, there is a lot going on in Washington. It can be hard to keep track of pending bills and how they may affect the patients you serve. With the American Healthcare Care Act (AHCA) passing through the House of Representatives, it is time for you to take a quick break from studying to learn about how this bill may affect Medicaid in your state.
What is Medicaid and how is it funded?
Medicaid is a government-funded health insurance program meant to help low-income families receive health care. It is an entitlement program that ensures anyone who is eligible is guaranteed coverage. Medicaid is currently funded by a joint federal-state finance model. The federal government provides each state with a certain amount of money based on the state’s income. According to the Kaiser Family Foundation, in the poorest states, the federal government pays for 73 percent of the Medicaid costs, while the national average is between 57 and 60 percent. As costs for providing care to enrollees rise so does the funding from the federal government. Each state is able to manage their own health care program while following basic requirements established by the federal government. With the passage of the Affordable Care Act, states have the option to expand Medicaid coverage to non-disabled adults who are slightly above the current income eligibility requirements. To be eligible, an individual’s income cannot exceed 138 percent of the nation’s poverty line. The federal government subsidizes most of the cost to provide coverage to these individuals and 31 states have opted to expand Medicaid.
How does Medicaid funding change under the AHCA?
The new bill proposes a capped allotment system. This change would place a limit per enrollee on the federal funds that states receive for their health insurance program. Once a state reaches its funding cap, the federal government will no longer pay for qualifying treatments. This means that patients who qualify for Medicaid are not guaranteed health care assistance, despite being eligible for coverage. Each individual state will have a calculated spending cap on health care expenditures, which is set irrespective to the actual rise in Medicaid costs. As the UCLA Center of Health Policy Brief states, this could limit health care for elders, children, disabled people and those made eligible for Medicaid under the Affordable Care Act. For the 31 states that opted to expand Medicaid, those funds would be eliminated by 2020. According to Health Affairs, these funding cuts may leave approximately 11 million Americans uninsured.
What does this mean for dentistry?
Limiting health care expenditure may have negative impacts on the individuals who are receiving oral care benefits through Medicaid. Currently, Medicaid guarantees emergency, restorative, and preventive treatment for children. Medicaid dental care coverage is largely dependent on the funds that the program receives from the federal government. As indicated by the May issue of the Advocacy Brief, this new bill could negatively impact access to preventive dental care for children in certain states. With the new funding caps proposed by the AHCA, publicly insured pediatric patients may not be guaranteed dental treatment. This can only exacerbate the dental caries epidemic in our nation, which is already the leading chronic disease in children. According to the Centers for Disease Control (CDC), tooth decay (cavities) is one of the most common chronic conditions of childhood in the United States. The percentage of children and adolescents aged 5 to 19 years with untreated tooth decay is twice as high for those from low-income families (25%) compared with children from higher-income households (11%).
What can you do?
As dental professionals, it is our duty to advocate for our patients. With the American Health Care Act being reviewed by the Senate, it is important to reach out to your senators and share how this bill may affect your patients.
~Walter Fuentes, Los Angeles ’19, Legislative Coordinator, Districts 10 & 11