‘More People Have Access to Oral Health Services’: How West Virginia Is Using the Medicaid Adult Dental Coverage Checker

Jason Roush, DDS, realized early on in his career the importance of improving the oral health of all West Virginians. He started as a private practice dentist after graduating from the West Virginia University School of Dentistry in 1998, but he quickly started to look beyond the four walls of his office.

“I thought I could have a bigger impact working in the state government in the West Virginia Oral Health Program than what I could in the private sector,” Roush says.

Twelve years later, in 2010, he became West Virginia’s first full-time state dental director. He’s been in that position ever since.

“I’m blessed to work with passionate individuals that want to improve the health and well-being of the citizens of West Virginia,” he says.

During that tenure, one of the biggest challenges he has faced is how to strengthen dental benefits for adults on Medicaid: The state only provided coverage for emergency procedures.

That reality was reflected in 2020, when West Virginia appeared on the Medicaid Adult Dental Coverage Checker, an interactive tool that shows where a state’s Medicaid adult dental benefits package lies compared to other states. It looks at coverage of specific procedures and services, including allowed frequency, in eight service categories.

“The Coverage Checker allows states to see where their benefits package falls on a continuum from no benefits up to extensive,” says Stacey Auger, MPH, a policy consultant at CareQuest Institute. “In doing so, it allows them to identify areas for improvement and expansion.”

Moving to the Medicaid Adult Dental Coverage Checker

For many years, policymakers and advocates have relied on the classification system of the American Dental Association (ADA) for state Medicaid adult dental benefits. Adopted and adapted by other organizations, this system classifies Medicaid adult dental benefits into four categories: extensive, limited, emergency, and none. Using the ADA’s classification system, a state’s dental benefits package may be considered extensive but can include services that are not among those that the best evidence shows are necessary to maintain oral health.

“CareQuest Institute convened a workgroup that quickly decided the oral health community would benefit from a new assessment tool,” Auger says. “We wanted to develop something that moved us beyond simply counting the number of procedures covered.”

While this classification system served the oral health community well for many years, four leading oral health organizations decided that states would benefit from a classification system that provides clear guidance on:

• the specific covered service categories necessary to constitute an extensive benefit
• the specific procedures to be covered within each service category
• the specific service frequency to be covered
• whether coverage is offered to all adult Medicaid beneficiaries or only to select subset(s) (e.g., individuals who are pregnant, people with disabilities, etc.)

The Adult Dental Medicaid Coverage Checker is designed to meet these needs.

CareQuest Institute released a new round of surveying earlier this month, and the Coverage Checker will be updated with the new data later this spring.

“We are really excited to have launched the new round of surveying and to be able to create a visual representation of the many expansions in coverage that have happened since 2020,” says Michael Monopoli, DMD, MPH, MS, FACD, FICD, vice president of grant strategy at CareQuest Institute. “Starting this year, surveying will be done annually. Having year-over-year data will allow users to track movement in benefit offerings over time and to better understand the coverage landscape at the state and national levels.”

West Virginia Strengthens Dental Benefits for Adults

The Coverage Checker’s results are pulled from a survey state dental directors complete and share with CareQuest Institute. The data represent a snapshot in time and are reflective of coverage offered by each state at the time of completion. Looking at the results of the 2020 survey, which was released in summer 2022, West Virginia scored an 8 out of 32 on the Coverage Checker.

“I mean, we’re behind if you look at that first tracker compared to what other states are offering,” Roush says. “I think when you first see it, it’s kind of shock and awe. It confirms where you’re at. But once you get past that, then you start to visualize how you can use the tool to implement change.”

Roush says the tool is extremely useful for state leaders to see what bordering states are doing and covering, and it’s helpful for oral health advocates and supporters. The Coverage Checker doesn’t just provide numbers — it tells a story that oral health leaders can tell state lawmakers.

“I would use that tool and probably will use that tool in the new cycle in 2023, when it comes out, and make sure it’s disseminated amongst our partners — because those are the people that really educate, advocate, that really help tell the story,” Roush says.

The story is already getting better, something that will be reflected in the coming update of the Coverage Checker later this year.

In March 2020, West Virginia passed a state law that expanded dental coverage for adults on Medicaid. It provides $1,000 in coverage per year for adult Medicaid beneficiaries for diagnostic, preventive, and restorative dental services with prior authorization. That can help individuals get dentures, implants, bridges, or even corrective procedures, like root canals.

That law went into effect on January 1, 2021. Following a global pandemic, it may take some time before the impact of the expansion fully reaches the people of West Virginia.

“I don’t think we’ve seen the full potential of the benefit yet. We’ve had dental practices shut down for three months in the state,” Roush says. “We’re trying to roll something new out — I mean, that’s been a challenge in and of itself. You’ve got to educate the providers. You’ve got to educate the community. It’s been a success but also a challenge.”

With the positive momentum, Roush believes West Virginia’s number on the Checker will improve drastically — and likely more than double.

“I don’t know what it’ll be — I’m hoping in the 20s,” Roush says. “But when you look at that, what’s that mean? To me, it looks like we have a lot more people who have access to oral health services.”