FOR IMMEDIATE RELEASE
30 June 2022
Washington, D.C. – Today, Congresswoman Nanette Diaz Barragán (CA-44), member of the House Energy & Commerce Health Subcommittee, and Congressman Lloyd Doggett (TX-35), Chairman of the House Ways and Means Health Subcommittee, led a group of 112 Members to ask the Centers for Medicare and Medicaid Services (CMS) to use its existing authority to improve coverage of medically necessary dental services. The Members urge CMS to deliver more coverage as evidence shows that dental health is critical to our overall health. Additionally, it is estimated that 68% of African Americans and 61% of Hispanics have not seen a dentist in the past year, increasing the urgency of expanding care to reduce health inequities.
“Dental care is a critical aspect of our overall health, especially as we get older. Poor dental health can dramatically worsen conditions like Parkinson’s Disease, Multiple Sclerosis, and Diabetes. It can also interfere with cancer treatment and diminish quality of life,” said Rep. Barragán. “Poor oral health not only impacts nutrition, but also causes social and emotional problems. In California, nearly one third of seniors suffer from untreated tooth decay and nearly one in ten seniors have complete tooth loss. I am proud to lead this effort with Rep. Doggett in encouraging CMS to expand its dental coverage for Medicare recipients and save seniors thousands of dollars in visits and procedures that can result from poor dental health. I remain committed to adding full dental coverage as part of Medicare’s services.”
“Our Nation’s seniors deserve so much more than half measures and half health,” said Congressman Doggett. “While legislation such as my Medicare Dental, Vision, and Hearing Benefit Act is essential to assure comprehensive coverage, CMS can deliver stronger dental care for more Medicare beneficiaries now and strengthen the health of Americans across the country. An overly narrow and outmoded interpretation of the Medicare statute must be updated to account for medical evidence of oral health’s strong connection to overall health.”
“No one should have to choose between getting the dental care they need to be healthy and putting food on the table,” said Melissa Burroughs, Director of the Oral Health for All campaign and Associate Director of Strategic Partnerships, Families USA. “Families USA appreciates the leadership from members of the House and Senate urging the Centers for Medicare and Medicaid Services to use their existing authority to maximize the definition of medically necessary dental care in Medicare. We look forward to working with Congress and the Administration to ensure that people who get their care through Medicare can get and stay healthy by ensuring their access to important oral health coverage.”
“It is estimated that two-thirds of Medicare beneficiaries have periodontal disease, yet nearly half of beneficiaries do not have dental coverage, and those who do must pay additional premiums and copayments for what is often highly restrictive coverage,” the Members write. “Lack of access to medically necessary dental treatment can worsen other health conditions, thereby increasing Medicare’s costs for treating their illnesses…Providing medically necessary oral and dental treatment has the potential to reduce costs and improve patient outcomes. By providing coverage for the treatment of periodontal disease for individuals with heart disease, stroke, and diabetes, one Avalere study estimates Medicare could save $63.5 billion over ten years.”
The Members illustrate the clinical and fiscal utility of coverage, and conclude with: “To improve patient outcomes, promote greater health equity, and reduce Medicare spending, we urge CMS to use existing regulatory authority to improve coverage of medically necessary oral and dental care.”
Read the entire letter, with the full list of signatories, here or below:
Dear Administrator Brooks-LaSure:
As a growing body of evidence demonstrates oral health’s connection to overall wellness, we write to urge you to use existing regulatory authority to improve Medicare coverage of medically necessary oral and dental treatment.
It is estimated that two-thirds of Medicare beneficiaries have periodontal disease, yet nearly half of beneficiaries do not have dental coverage, and those who do must pay additional premiums and copayments for what is often highly restrictive coverage. Lack of insurance coverage has resulted in Medicare beneficiaries neglecting their oral health. Nearly half of beneficiaries have not seen a dentist in the past year, with much higher rates among communities of color (68% of African Americans and 61% of Hispanics) and low-income beneficiaries (73%).[1] One in five beneficiaries who have used dental services spent more than $1,000 out-of-pocket for care.[2]
Lack of access to medically necessary dental treatment can worsen other health conditions, thereby increasing Medicare’s costs for treating their illnesses. Periodontal disease has been linked to other health conditions, including diabetes, stroke, heart disease, kidney disease, and cancer.[3] Nearly twenty percent of seniors have lost all their teeth and 68 percent have gum disease, resulting in seniors eating unhealthy foods that are easier to chew, but lead to elevated blood sugar and uncontrolled diabetes.[4] Gum disease is also linked to poor cognitive function, increasing the risk of developing dementia and Alzheimer’s.[5] More than 90 percent of all systemic diseases have oral manifestations, such as swollen gums, mouth ulcers, and more.[6]
Providing medically necessary oral and dental treatment has the potential to reduce costs and improve patient outcomes. By providing coverage for the treatment of periodontal disease for individuals with heart disease, stroke, and diabetes, one Avalere study estimates Medicare could save $63.5 billion over ten years.[7]
Section 1862(a)(12) of the Social Security Act excludes Medicare coverage of routine dental services; however, that provision permits coverage when treatment is medically necessary. Senate Report No. 89-404 (1965) expressly provides that payment canbe made when there is appropriate medical justification, such as when the item or service is necessary for the diagnosis or treatment of a Medicare-covered disease, illness, or injury.
Currently, the Centers for Medicare and Medicaid Services (CMS) interprets this provision to provide coverage for “dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw following accidental injury), or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw. Medicare will also make payment for oral examinations, but not treatment, preceding kidney transplantation or heart valve replacement, under certain circumstances.”[8]
CMS should improve its coverage of dental services to encompass all medically necessary situations. Below are a few representative examples that illustrate the clinical and fiscal utility of such coverage:
- Emergency department visits and hospitalizations for medical problems in which oral/dental bacteria are an underlying cause, such as an infected cardiac or orthopedic prosthesis.
- Parkinson’s Disease, in which dentally sourced bacteria can contribute to aspiration pneumonia, and/or infection of medical devices, such as deep brain neurostimulators and artificial knees and hips.
- Bacterial endocarditis and worsened stroke outcomes due to an increased inflammatory burden caused by unresolved dental infections.
- Multiple sclerosis, in which oral/dental bacteria can cause serious infection for patients taking pharmaceuticals that suppress the immune system, such as disease-modifying therapeutic drugs.
- Delay or interruption of treatment for various gastrointestinal diseases, including certain liver and inflammatory bowel diseases (IBD) due to untreated oral/dental disease.
- Rheumatologic disease, for which patients must often take medication that suppress their immune systems, thereby making them more susceptible to infection from untreated oral/dental disease.
- Diabetes management compromised by periodontal infections, which increases the risk of kidney disease and failure, vascular dementia, visual degradation, podiatric complications, cardiac disease and stroke.
- Arthroplasty of the hip and knee, which cannot safely proceed without prior resolution of oral/dental disease because of the risk of post-operative infection.
- Cancer treatment, in which leukopenia from chemotherapy increases the risk of dentally sourced bacteria causing sepsis or other serious complications.
- Organ transplantation, for which dental infections risk serious complications because patients are pharmacologically immunosuppressed to prevent rejection.
- Metastatic lung, breast, prostate and colon cancers, multiple myeloma, and hypercalcemia, which often involve bisphosphonate drugs, for which dental health is advised to prevent osteonecrosis of the jaw.
- Implanted heart valves, arterial stents, and stent grafts, which are at risk of infection and costly complications due to bacteria sourced from dental infections.
To improve patient outcomes, promote greater health equity, and reduce Medicare spending, we urge CMS to use existing regulatory authority to improve coverage of medically necessary oral and dental care.
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Nanette Diaz Barragán is proud to represent California’s 44th Congressional District, which includes the communities of Carson, Compton, Florence-Firestone, Lynwood, North Long Beach, Rancho Dominguez, San Pedro, South Gate, Walnut Park, Watts, Willowbrook and Wilmington. She serves as chairwoman of the House Homeland Security Committee’s Subcommittee on Border Security, and on the House Energy and Commerce Health, Energy, and Environment & Climate Change Subcommittees.
[1] https://www.kff.org/medicare/issue-brief/medicare-and-dental-coverage-a-closer-look/
[2] https://www.kff.org/medicare/issue-brief/medicare-and-dental-coverage-a-closer-look/
[3] https://www.healthaffairs.org/do/10.1377/forefront.20190227.354079/full/
[4] https://www.healthaffairs.org/do/10.1377/forefront.20190227.354079/full/
[5] https://pubmed.ncbi.nlm.nih.gov/27685603/
[6] https://www.deltadentalins.com/oral_health/dentalhealth.html
[7]https://oralhealth.hsdm.harvard.edu/files/oralhealth/files/avalere_health_estimated_impact_of_medicare_periodontal_coverage.pdf
[8] https://www.cms.gov/Medicare/Coverage/MedicareDentalCoverage