Dental Care for Disadvantaged Pregnant Women in AZ

David Schlinkert
September 11, 2018

Pregnant women below the poverty line in Arizona face numerous headaches in their everyday lives, including access to affordable dental care.

Pregnant women are more likely to experience swelling and bleeding of the gums compared to non-pregnant women,1 and pregnant women with periodontal disease are more likely to have pre-term births and low-birthweight babies.2
 
Postpartum women can also transmit tooth decay pathogens to their infants increasing their risk of early childhood cavities.3 Cavities are the most common chronic disease affecting children, and they can lead to serious health problems.4

Proper dental care during a woman's pregnancy has the potential to reduce healthcare costs because a woman's child is more likely to be born healthy.

In 2018, the Arizona State Legislature considered a bill that would have provided non-emergency dental care to pregnant women over the age of 21. The issue received support in both the House and the Senate, but failed to pass into law because of a prediction that the bill would create expensive secondary costs.

According to the Arizona Public Health Association (AZPHA), the Joint Legislative Budget Committee predicted the potential increase in secondary costs of the bill to be $3.7 million because approximately 25 percent of the 5,000 women in the expansion population will go to the dentist for preventative care, which will change their health insurance eligibility category to a higher state match rate.5
 
Will Humble, the executive director at the AZPHA, said that the direct care cost of SB1445 is $268,000, but if it prevented two to three low-birth weight babies from being admitted into a Neonatal Intensive Care Unit, it would cover the cost of providing dental services offered by SB1445.

Non-emergency dental care for pregnant woman has a financial benefit to the taxpayer. According to a study published in Pediatric Dentistry, "The average cost of a Medicaid enrollee's inpatient hospital treatment for dental problems is nearly 10 times more expensive than the cost of preventive care delivered in a dentist's office."6 And in Arizona, "taxpayers have borne a major portion of dental-related ER costs. In 2005, roughly 46 percent of the state's ER visits for dental reasons were made by Arizona Health Care Cost Containment System (AHCCCS is Arizona's version of Medicaid) enrollees."7

Debbie Vishnevsky, policy analyst at Children's Dental Health Project in Washington D.C., says the argument behind expanding dental care for pregnant women is two-fold. Philosophically, we have to accept the value and merit of Medicaid - if dental coverage does bring on secondary costs, "that's the point of the program, to insure vulnerable low-income women."

Second, the notion that there are "waves of women waiting for state paid dental care to sign up or switch health insurance is preposterous." And, even if pregnant women do receive access to Medicaid benefits many women still go without the care they need. Nationally, utilization rates for this type of benefit are low, and some dentists may refuse to provide dental services to pregnant women, or not accept Medicaid.8

Three years ago, the state of Virginia added comprehensive maternal oral healthcare coverage. Sarah Holland, Chief Executive Officer of the Virginia Oral Health Coalition, said, "If pregnant women do get additional non-emergency coverage that's a good thing because it will actually save the state money if the mom is getting prenatal care." Another added benefit is that by introducing moms to oral healthcare it increases the likelihood of getting her child excellent dental care early on. "So you're improving health and saving money for two people," Holland said.
 
A bill to provide non-emergency dental benefits for pregnant women will have to start from scratch next year, and it will have to move forward without its lead sponsor, state Senate majority leader Kimberly Yee.

Despite these obstacles, the next bill will most likely have bipartisan support because it will provide key healthcare services for vulnerable women and their unborn babies.

The next legislative session begins January 14, 2019.

UPDATE:
Here is the new bill number for the dental health bill for homeless pregnant and parenting women.
SB 1088 Dental Care During Pregnancy (Carter)
This bill would expand AHCCCS covered services to include comprehensive dental coverage during pregnancy and appropriate the required state match funding.

1American Pregnancy Association. N.d. Pregnancy and Dental Work. http://americanpregnancy.org/pregnancy-health/dental-work-and-pregnancy/

2American Dental Association. N.d. Oral Health Conditions During Pregnancy. https://www.ada.org/en/member-center/oral-health-topics/pregnancy

3Megan K. Kloetzel, MD, MPH, Colleen E. Huebner, PhD, MPH, and Peter Milgrom, DDS. (2011). Referrals to Dental Care During Pregnancy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074205/

4Caplan, L., Erwin, K., Lense, E., Hicks, J. (2008). The Potential Role of Breast‐Feeding and Other Factors in Helping to Reduce Early Childhood Caries. Journal of Public Health Dentistry. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1752-7325.2007.00080.x

5AZ Public Health Policy Update. (2018). Retrieved from: http://www.azpha.org/wills-blog/2018/4/23/az-public-health-policy-update-april-23-2018

6E. Pettinato, M. Webb and S.N. Seale, "A comparison of Medicaid reimbursement for nondefinitive pediatric dental treatment in the emergency room versus periodic preventive care," Pediatric Dentistry 22 (2000): 463-468; C.N. Bertolami, "Health Care Reform Must Include Dental Care," Roll Call, (April 23, 2009)

7E.F. Shortridge and J.R. Moore, "Use of Emergency Departments for Conditions Related to Poor Oral Health Care,"
Walsh Center for Rural Health Analysis, pg v, (August 2010), accessed January 18, 2012, http://www3.norc.org/NR/ rdonlyres/DCBE76E8-3148-4085-9211-FB79AFD6BA51/0/OralHealthFinal2.pdf

8Saint Louis, C. (2013) Obstacles for Women Seeking Dental Care. New York Times. Retrieved from: https://well.blogs.nytimes.com/2013/05/06/obstacles-for-pregnant-women-seeking-dental-care/