New and Expectant Mothers Bear the Brunt of Medicaid Shortfalls

Our knowledge of just how connected oral health is to the rest of the body is continually increasing. Yet, there are no federal provisions for adult dental care, particularly since Medicaid began to phase out extended coverage post-pandemic.¹

In April 2022, federal incentives became available for states to extend Medicaid post-partum coverage to a year. By October 2022, every state in the union, including the District of Columbia began to offer some form of dental coverage for pregnant and post-partum Medicaid enrollees for at least 60 days after they give birth. Beyond this, the scope of coverage varies from state to state.¹

Currently, 36 states and the District of Columbia are extending or preparing to extend such coverage. The remaining 14 states continue to offer just 60 days of postpartum coverage. But this does not address the totality of the problem. As the United States Centers for Disease Control considers the post-partum period to last 12 months, this leaves many new mothers without care options for 10 months.¹

WHY ORAL HEALTH MAINTENANCE IS CRITICAL

Due to the hormonal changes that occur during pregnancy, women are left more vulnerable to increased inflammatory response to dental plaque during pregnancy. This can lead to what’s known as “pregnancy gingivitis.”¹

According to a recent report by the CareQuest Institute, about 60% to 75% of pregnant people experience such oral health issues. Untreated, these can lead to more systemic problems and can increase the odds of poor birth outcomes and major complications such as preeclampsia, preterm birth, and low-birth-weight infants. Black women were found to be 27% more at risk than white women.¹

The report’s authors further stress the linkage between children’s oral health outcomes and the post-partum parent’s oral health habits.¹ This is especially pertinent considering we now know caries to be a communicable disease, which may be spread from mother to child through something as innocent as a kiss.

Countless experts in medicine and dentistry stress the importance and safety of professional oral care maintenance during and after pregnancy.

BARRIERS TO CARE

Some dentists are hesitant to provide restorative procedures during pregnancy due to misconceptions about safety. A 2017 study found that fewer than half of dentists questioned were willing to provide restorative procedures or periodontal scaling and root planing throughout all pregnancy stages.^1,2

But cost is another issue as many dental offices do not accept Medicaid due to inadequate reimbursement. According to one survey, 72.9% of dentists said that poor compensation for time spent counseling pregnant patients was the highest barrier to the provision of care.³

The report’s authors suggest that if each state were to ensure Medicaid dental coverage for at least a year after birth, it could lower medical care costs and reduce expensive trips to the emergency department. It could also improve health equity and reduce disparities in birth outcomes. They contend that an expansion in Medicaid benefits is a sound investment that is likely to have far-reaching beneficial financial and social impacts.¹

References

1. Auger S, Preston R, Tranby EP, Heaton LJ. The role of Medicaid adult dental benefits during pregnancy and postpartum.
2. Mayberry ME, Norrix E, Farrell C. MDA dentists and pregnant patients: a survey of attitudes and practice. J Mich Dent Assoc. 2017;99:54-62.
3. Shuk-Yin R, Milgrom P, Huebner CE, Conrad DA. Dentists’ perceptions of barriers to providing dental care to pregnant women. Women’s Health Issues. 2010;20:359-365.