Oral Health

GAO's analysis of the most recent national health surveys (1994-97) found that low-income people have disproportionately high levels of dental disease. Poor children had five times more untreated dental cavities than did children in wealthier families, and poor adults were much more likely to have lost six or more teeth to decay and gum disease than were their higher-income peers. Minorities also suffered high levels of dental disease. Dental problems not only cause pain and infection but lead to millions of lost school days and workdays each year. Although every state Medicaid program offers dental coverage for children and most programs cover adults eligible for Medicaid, the use of dental services by low-income people is low. States are required to provide comprehensive dental benefits for children enrolled in Medicaid, and the State Children's Health Insurance Program provides variable but often substantial levels of dental coverage to eligible low-income children in all but two states. Adult dental services, although optional under Medicaid, are covered to some extent in about two-thirds of the states. The availability of coverage does not, in itself, however, bridge the income gap and increase the likelihood of a visit to the dentist. For example, GAO's analysis of 1995 Medicaid claims data showed that only 29 percent of enrolled adults had visited the dentist in the preceding year, less than half the rate of higher-income adults. National survey data also showed that poor children and adults visited the dentist at about half the rate of their higher-income counterparts in 1996--numbers that have essentially remained unchanged since 1977.

GAO noted that: (1) dental disease is a chronic problem among many low-income and vulnerable populations; (2) GAO's analysis of the most recent national health surveys (1994-1997) showed that relative to more affluent segments of the population, low-income populations had a disproportionate level of dental disease; (3) for example, poor children had five times more untreated dental caries (cavities) than children in higher-income families, and poor adults were much more likely to have lost six or more teeth to decay and gum disease than higher-income adults; (4) minority populations also faced high levels of dental disease; (5) dental problems result in pain, infection, and millions of lost school days and workdays each year; (6) although every state Medicaid program offers dental coverage for children and most programs cover adults eligible for Medicaid, use of dental services by low-income people is low; (7) states are required to provide comprehensive dental benefits for children enrolled in Medicaid, and the State Children's Health Insurance Program provides variable but often substantial levels of dental coverage to eligible low-income children in all but two states; (8) adult dental services, although optional under Medicaid, are covered to some extent in about two-thirds of the states; (9) the availability of coverage does not, however, bridge the income gap to equalize the likelihood of visiting a dentist; (10) for example, GAO's analysis of 1995 Medicaid claims data showed that only 29 percent of enrolled adults had visited the dentist in the preceding year, less than half the rate of higher-income adults; and (11) national survey data also showed that in 1996 poor children and adults visited the dentist at about half the rate of their higher-income counterparts--numbers that had stayed relatively unchanged since 1977.