It took oral health advocates nearly 25 years to persuade New Hampshire lawmakers to provide adults on Medicaid coverage for basic dental care. Gail Brown, one of those advocates, said she saw that investment pay dividends in far less time.
Brown was stopped this spring while bringing cakes to a party celebrating New Hampshire Smiles’ first year by a woman who wanted her to know how grateful her neighbor was to finally be able to see a dentist. Brown had heard something similar that morning when she picked up the cakes at a grocery store bakery. The woman behind the counter said the program had allowed her to see a dentist and her friend to get dentures.
“She said, ‘You don’t know how big a difference this has made in our lives,’” Brown, executive director of the New Hampshire Health Coalition, recalled. “I experienced this in all kinds of places.”
Brown and other oral health advocates also hear this: There are too few dentists for the nearly 85,000 people now eligible for expanded coverage, making it difficult for them to get appointments. Of the state’s nearly 970 dentists and oral surgeons, 163 have signed on. The goal is to reach 200.
The program also includes a mobile dental clinic that has made 84 stops across the state and continues to add dates.
Growing that roster has proven difficult in part because the state has a shortage of dentists. Medicaid reimburses providers less than commercial insurance, and some providers are apprehensive about the unknowns of a new Medicaid program.
New Hampshire Smiles, which the Legislature passed in 2022, could face its biggest test next year, when a new group of lawmakers decides whether to renew funding. Its future is uncertain given this will be the first budget without revenue from the now-repealed interest and dividends tax or pandemic aid.
But Brown and others who’ve fought for decades to pass the program say they are optimistic.
“I think there’s always a slight doubt, but I’m not worried about it because it’s working,” said Tom Raffio, president and CEO of Northeast Delta Dental, which is managing the program for the state. “It’s not perfect yet but we’re moving in the right direction. So that’s the key.”
‘It will pay off in the long term’
New Hampshire was one of about 10 states that was limiting adults’ Medicaid coverage to only dental emergencies like tooth extractions before lawmakers expanded the program. In its first 15 months, New Hampshire Smiles has paid more than 38,000 claims for nearly 13,160 people, Raffio said.
Lawmakers covered the first three years of benefits with federal Medicaid dollars and $21 million the state secured in a 2022 legal settlement. That money will get the program through at least 2025 but then will require about $7.5 million a year in state money to continue.
Henry Lipman, the state’s Medicaid director, said maintaining that investment is critical not only for Granite Staters’ health but also employers who need workers and the state’s ability to control Medicaid costs.
He noted that when oral health problems lead to infection, strokes, or heart disease, Medicaid holders without dental insurance seek more expensive care in emergency rooms – at the state’s expense. Or, they turn to illicit drugs to soothe the pain. And, employers are often reluctant to hire individuals with tooth decay, missing teeth, and other oral health problems.
“The long-run investment in terms of oral health, it will pay off in the long term,” Lipman said. “Dental (care for adults on Medicaid) is not sort of a freestanding program in my mind. It’s part of our overall efforts to manage the long-run costs of Medicaid by providing the appropriate services at the appropriate time and avoiding more serious conditions that are much more expensive.”
Room to grow
Lipman and Raffio at Northeast Delta Dental said their top priority is increasing the number of dentists willing to see Medicaid patients and patients with disabilities in particular. The amount of money Northeast Delta Dental is returning to the state reflects the need – and potential for growth.
Ideally, the insurance company and the state aimed to spend about 80 cents of every dollar provided by the state on care. The remainder would be used to administer the program. Instead, the program is paying out only about 20 cents of every dollar to providers because the shortage of providers limits the number of appointments.
The state included two incentives in its contract to entice providers to sign up.
It provides eligible patients free transportation to and from appointments. Friends and family who transport eligible patients can also get reimbursement for mileage. The program also pays for care managers who can help with paperwork questions, resolving issues with missed appointments, and other questions.
Since the start of the program, Raffio and the state have negotiated increases in reimbursement for certain dental procedures to come closer to providers’ actual costs. Northeast Delta Dental offered sign-on bonuses and is providing loan repayment for dentists who participate.
Tracy Gilman said her team at Northeast Delta Dental has been trying to recruit more providers by visiting them in person, to explain the program and answer questions. This year, they’ve made 106 visits, 83 of them with providers who were not participating.
Those visits also include getting feedback from providers who are seeing patients.
“Many of our participating providers have shared with us that they believe the program has improved and claims processing and other administrative processes are operating at an efficient level, reducing administrative burden,” Gilman said.
She said claims data showed that many providers who initially said they were going to restrict the number of Medicaid patients have taken on more. Gilman’s team will continue contacting other providers to ask if they’d do the same.
This story was originally published by New Hampshire Bulletin.
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