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Description:

Oral health care coordination for individuals dually eligible for Medicare and Medicaid is a complicated task for several reasons:

• Coverage complexity. Dually eligible individuals navigate coverage for dental health care through both the Medicare and Medicaid programs. Although the Centers for Medicare & Medicaid Services (CMS) implemented final rules in January 2023 and January 2024 expanding Medicare coverage for certain “medically necessary” or acute dental health care services,^1,2 coverage for routine dental health care needs remains a patchwork through Medicaid programs that vary widely from one state to the next.³
• Provider shortages. Despite Medicaid program expansions for certain dental services, shortages of Medicaid-participating practitioners offering care to enrollees continue to limit access to care.⁴
• Health equity. Disparities in dental health access disproportionately affect dually eligible enrollees. For example, Black and Hispanic populations—both overrepresented in the dually eligible enrollee population—experience greater dental care access barriers and a higher burden of disease comorbidity than their White counterparts.⁵ Similarly, individuals with disabilities or who are homebound also face both a higher incidence of dental disease and greater barriers to care when compared with the general population.⁶

To overcome these challenges, health plans and providers are implementing strategies to meet the dental health care needs of dually eligible enrollees. This includes ensuring care plans and treatment are person-centered, improving access to dental care providers, working to reduce disparities to deliver more equitable care, and increasing awareness about the relationship between oral health and overall wellness.

Description: This webinar articulates the dental care needs of dually eligible individuals and highlights promising practices for health plans and providers to meet those needs. Speakers share strategies to support benefits and dental service coordination in a complex health care delivery landscape while addressing underlying dental health equity challenges facing the dually eligible population.

By the end of this interactive webinar, participants will be able to:

1. Understand the dental health care landscape for dually eligible individuals, including dental health care benefit structures, gaps in oral health care and services, and the effect of dental care on an individual’s overall health;
2. Summarize successful dental health care benefits and services management and care coordination strategies that plans can implement to meet the unique oral health needs of the dually eligible population;
3. Articulate why and how providers and plans apply a person-centered care approach to meet the oral health care needs of dually eligible individuals; and
4. Describe dental health care equity challenges that disproportionately affect dually eligible enrollees, as well as strategies to improve oral health care equity.

Featured Speakers:

1. Natalia Chalmers, DDS, MHSc, PhD, Chief Dental Officer, CMS
2. Carolyn Brown, DDS, Dental Director, and Marisa Cardarelli, MPH, Dental Benefits Manager, Health Plan of San Mateo
3. Jessica Serman, RN, Assistant Director of Clinical Services, Upper Peninsula Health Plan
4. Michael J. Helgeson, DDS, Chief Executive Officer, Apple Tree Dental

Featured Panel Discussion Facilitator:

1. Michael Windsor Johnson, DDS, MPH, Rear Admiral, Assistant Surgeon General, Chief Dental Officer, U.S. Public Health Service, National Chief Dentist, Federal Bureau of Prisons

Intended Audience:

This webinar is intended for a wide range of health care providers working with dually eligible enrollees, including health plans, dental health care providers and organizations, dental health care benefits specialists, care coordinators, and caregivers and families of dually eligible individuals.

Attachments:

Webinar Slides

Webinar Transcript

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¹Garvin, J. (2022). CMS Expands Medicare to Cover Medically Necessary Conditions Requiring Dental Services. ADA News. Retrieved from https://adanews.ada.org/ada-news/2022/november/cms-expands-medicare-to-cover-medically-necessary-conditions-requiring-dental-services/.

²Freed, M., Neuman, T., and Cubanski, J. (2023) Recent Changes to Medicare Coverage of Dental Services from the 2023 and 2024 Medicare Physician Fee Schedule Final Rules. Kaiser Family Foundation. Retrieved from https://www.kff.org/medicare/issue-brief/recent-changes-to-medicare-coverage-of-dental-services-from-the-2023-and-2024-medicare-physician-fee-schedule-final-rules/.

³Center for Health Care Strategies. (2019). Medicaid Adult Dental Benefits: An Overview (fact sheet). Retrieved from https://www.chcs.org/resource/medicaid-adult-dental-benefits-overview/.

⁴American Dental Association’s Health Policy Institute. (2022). Dentists who Participate in Medicaid: Who They Are, Where They Locate, How They Practice. Retrieved from https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/hpi/hpi_dentist_participation_medicaid_webinar_slides.pdf?rev=ca757c4dac654900b7eb1cbac2990fa3&hash=06C1E0E05A7BBF00AE9566D90BC27036.

⁵U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research. (2021). Oral Health in America: Advances and Challenges. Retrieved from https://www.nidcr.nih.gov/sites/default/files/2021-12/Oral-Health-in-America-Advances-and-Challenges.pdf.

⁶Ibid.