SB2459

SECTION 1. The legislature finds that oral disease is a significant health problem among many Hawaii residents, affecting their overall health and well-being. Since 2010, Hawaii has received a failing grade of "F" in three oral health report cards published by the Pew Center of the States due to multiple policy and systems issues in the State that has left the oral health of Hawaii's families and children in a state that is worse than the rest of the nation.

Access to regular oral healthcare varies greatly across the State, with rural and neighbor island residents and persons with low-income families experiencing greater access issues. Currently, approximately 180,000 adult medicaid beneficiaries are not getting the benefit of early oral disease detection and treatment for better overall health. Lack of access to dental coverage and oral healthcare is a health and social justice issue that disproportionately affects the poor, children, the elderly, and racial and ethnic minority groups.

In 2009, the State of Hawaii terminated all preventative and restorative dental care services for adult medicaid recipients and replaced it with emergency room services that are limited to pain relief, injuries, trauma, and tooth removal and extraction. Nationally, studies have shown that reducing or eliminating medicaid adult dental benefits has led to significant increases in dental-related emergency room visits and associated costs. In 2012 alone, Hawaii medicaid paid $4,800,000 for 1,691 adults for emergency room visits for preventable oral health problems, according to the department of health's Hawaii Oral Health: Key Findings report.

In Hawaii, a disproportionate number of adult medicaid beneficiaries ages twenty-one and older utilize emergency dental services. While they are twenty-five per cent of Hawaii's population, they represent fifty-six per cent of all emergency dental services. Just over 3,000 emergency room visits for acute oral health conditions occurred in 2016, totaling over $17,000,000 in direct costs, a cost that has more than doubled since 2007. Data also indicated that rural residents of the State, primarily from the north shore of Oahu and the islands of Kauai and Hawaii, were more likely than urban residents to go to the emergency room for dental problems.

The lack of preventative and restorative dentistry services for adult medicaid beneficiaries increases potential health care complications and costs for individuals living with diabetes, including an increased incidence of gum disease, increased difficulty controlling diabetes and an increased likelihood of coronary artery disease. These complications can all lead to increased disability and death. For diabetic medicaid beneficiaries, increased access to dental care could result in a cost savings between $118,000 and $1,700,000 for diabetic medical care for all beneficiaries, according to 2019 estimates by the Healthy Policy Institute of the American Dental Association.

For pregnant adult medicaid beneficiaries, ensuring good oral health during pregnancy may reduce pregnancy complications such as pre-eclampsia, giving birth too soon, or having low birth-weight babies. The average cost of services for the birth of a healthy newborn is approximately $5,000. In contrast, the cost of services for a premature or underweight newborn can range from $200,000 to $2,000,000.

Poor oral health is clinically proven to have serious adverse impact on overall health and well-being. It is linked to an array of acute and chronic health conditions including heart disease, diabetes, stroke, depression, low birth weight, and premature birth among others. Tooth decay is almost completely preventable. However, preventive services, early diagnosis, and interventions that can halt or slow the progression of most oral diseases is currently unavailable to adult medicaid beneficiaries in the State. Problems that could have been addressed early, or even prevented, continue to progress, leading to poor health outcomes and lower quality of life.

Dental care coverage is positively associated with access to and utilization of oral healthcare. Research indicates that children and adults with dental coverage are significantly more likely to seek and use regular dental services than those who are uninsured.

Individuals enrolled in medicaid have an increased likelihood of disparities in health care outcomes based on income. The prevalence of dental disease and tooth loss is disproportionately high among low-income populations. Insufficient coverage or access to care often further disadvantages medicaid recipients, driving poor health outcomes and higher costs.

Expanded adult dental benefits can have tremendous positive impacts on state medicaid populations. It has been shown that individuals with dental benefits are forty-two per cent more likely to have a dental checkup within the year than individuals who do not have coverage. Parents who receive dental care are also more likely to take their children to the dentist as well.

Medicaid provides federal funds for health care coverage to eligible individuals with low incomes, including children and their parents, pregnant women, the elderly, and persons with disabilities. The federal government will match up to fifty per cent of a state's investment in reinstating preventative and restorative dental benefits for adult medicaid beneficiaries.

Although comprehensive dental coverage is mandatory for children enrolled in medicaid, dental benefits for medicaid-eligible adults are optional. Currently, thirty-four states offer comprehensive or limited preventive and restorative benefits to adults on medicaid.

Adding expanded dental services benefits for the State's adult medicaid enrollees will reduce the number of acute oral health-related emergency room visits and improve these individuals' chronic disease risks and overall health status. Current estimates on costs of restoring expanded benefits to adult medicaid recipients in Hawaii that will provide a range of preventive and restorative benefits for recipients to help maintain and improve their oral health are being developed by the department of human services MedQuest division.

It has been over a decade since the State removed all but emergency medicaid adult dental benefits. The legislature finds that it is in the best interest of the State and its residents to expand access to care by restoring dental benefits to adult medicaid enrollees. Accordingly, the purpose of this Act is to appropriate funds to restore diagnostic, preventive, and restorative dental benefits to adult medicaid enrollees.

SECTION 2. There is appropriated out of the general revenues of the State of Hawaii the sum of $7,000,000 or so much thereof as may be necessary for fiscal year 2020-2021 to restore diagnostic, preventive, and restorative dental benefits to adult medicaid enrollees; provided that the department of human services shall obtain the maximum federal matching funds available for this expenditure.

The sums appropriated shall be expended by the department of human services for the purposes of this Act.

SECTION 3. This Act shall take effect on July 1, 2020.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	2459
THIRTIETH LEGISLATURE, 2020
STATE OF HAWAII