State Medicaid and CHIP programs have made significant strides in improving low-income children's access to and use of dental care, but access to dental care for low-income adults lags far behind. To probe current opportunities, challenges, and strategies related to expanding access to oral health care for adults in Medicaid, the Kaiser Commission on Medicaid and the Uninsured convened a group of experts and stakeholders in Spring 2016 to discuss the issues. Several key themes emerged from the conversation: (1) Oral disease affects overall health and well-being and also bears on other major national concerns. Poor oral health has adverse impacts on overall health and well-being. The detrimental effects of poor oral health and lack of access to services among low-income adults also ramify to employability, opiate abuse, emergency department use, and health disparities. (2) Good oral health among low-income adults is an achievable goal. The science of dental caries is understood and dentistry possesses the clinical tools to prevent and manage it. Emphasizing that this capability exists and raising awareness about the burden and impact of oral disease on low-income adults could increase support and political will to expand Medicaid dental coverage for adults. (3) States have levers in Medicaid to improve access to dental care for adults. States can expand Medicaid to low-income adults, expand dental benefits, ease administrative burdens that dampen dentist participation, improve provider payment, and make strategic use of incentives to improve access to and utilization of dental care. (4) Innovative workforce approaches can help maximize current oral health resources and expand access. Elimination of scope-of-practice restrictions, new provider types, teledentistry, and health center expansion can increase the supply and availability of oral health care to address the growing demand for care among low-income adults as coverage expands. (5) Experts say that ending the oral health crisis will not be possible without transforming the oral health care system. Ending the epidemic of poor oral health among poor populations will require an oral health system centered on prevention and evidence-based care, not driven by an invariable set of covered benefits; integration of oral and primary care; and community-based models of care.
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