A tale of two safety nets

Abstract

The mouth incontestably is an important part of the body, no matter what your age. But when you look at many public policies in the health sector of the United States, the importance of the oral cavity may not seem so obvious. Take Medicaid, for example. Dental benefits for children are mandatory. For adults, however, dental benefits are optional, and states can select the level of coverage to provide—one option being no coverage at all. Within the Affordable Care Act, pediatric dental services are one of 10 essential, required health benefits. For adults, dental care is not considered “essential” within the Act. Clearly, among policymakers, the status of the mouth changes with age. Of course, there could very well be sound economic, political or social reasons for this. For example, with limited resources, investments in children’s oral care and disease prevention might be viewed as having the biggest bang for the buck in terms of lifetime gains in oral health and, therefore, should be prioritized. Whatever the reasons, it is important to take a hard look at the data to understand the impact of what are essentially two different safety nets when it comes to dental care—one for low-income children and one for low-income adults. The past decade has seen a steady increase in the rate of dental care utilization among low-income