Medicaid expansion critical for ensuring WV dental care access / Public News Service

West Virginia’s adult Medicaid dental benefit plays a critical role in helping to reduce oral health disparities, experts said.

Expansion changes including the dental benefit went into effect in 2021.

Gina Sharps, executive director of the West Virginia Oral Health Coalition, said given the state’s severe shortage of dental providers, it will take more time to see the benefit’s effect. She added tooth decay and gum disease are linked to a host of chronic diseases.

“When we look at the science, there are clear associations between oral health in various systemic diseases such as diabetes and heart disease,” Sharps pointed out. “Even down to 8% of cases of infective endocarditis are caused by oral infections.”

According to a 2023 report, more than 24% of dental practices in West Virginia were no longer accepting new patients, or average wait times for the first available appointment were months away.

Sharps added before the Medicaid adult dental benefit, folks would resort to using the emergency room if they had a toothache and end up saddled with medical debt.

“You would go from a from an $87 toothache to an $1,800 toothache,” Sharps observed.

Organizations like the West Virginia Dental Hygienist Association want to expand the scope of practice for hygienists to help fill care gaps as the state continues to lose providers. Sharps said policymakers could take action to increase the odds people with tooth trouble can see a dentist.

“Fifty-two out of our 55 counties are Dental Health Professional Shortage Areas,” Sharps explained. “Which means they are areas designated as having shortages of dentists.”

According to the CareQuest Institute for Oral Health, in 2021, the nation’s poorest households paid more than seven times more for dental care than higher-income and insured households.

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A Supreme Court decision in U.S. v. Skrmetti, challenging Tennessee’s ban on gender-affirming care for minors, is expected by mid-2025.

Since 2021, 24 states have enacted categorical bans on gender-affirming medical care.

Lucas Cameron-Vaughn, staff attorney for the ACLU of Tennessee, said the initial lawsuit is on behalf of Samantha and Brian Williams of Nashville and their 16-year-old transgender daughter, as well as two other plaintiff families filing anonymously, and a Memphis-based physician. They are anticipating the decision, which is expected next year.

“This is the first case to look at whether the equal-protection clause of the U.S. Constitution protects transgender people, in this case, transgender youths,” Cameron-Vaughn explained. “And whether or not it is constitutional that the state of Tennessee passed a ban on health care for transgender youths.”

The ACLU reported more than 100,000 transgender minors live in states with bans on their health care. Tennessee Attorney General Jonathan Skrmetti stated they were defending Tennessee’s law safeguarding children from irreversible and unverified gender transition procedures. Tennessee argued its ban does not discriminate based on sex.

Cameron-Vaughn pointed out the broader implications of the case will depend on the justices’ ruling but it could influence whether states such as Tennessee can pass sex-based laws, such as those banning IVF or birth control, and whether such laws will be seriously reviewed by courts. He argued some recently passed laws negatively target transgender youths.

“It’s important for Tennesseans to understand that the Legislature, over the past few years, has passed lots of laws directed at transgender young people,” Cameron-Vaughn emphasized. “It is really affecting them and their mental health.”

With the new administration, Cameron-Vaughn noted politicians made many claims about gender-affirming care during the campaign. Whether the claims will materialize is uncertain. He added the ACLU is prepared to continue to advocate for Tennessee’s gender-affirming care and will fight to protect rights and block further such legislation.

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Open enrollment for health insurance is underway, and in Wyoming, the number of enrollees so far this year is just below last year’s rate. Experts advise there’s an important deadline this weekend. According to the Centers for Medicare and Medicaid Services, nearly 988,000 new U.S. consumers enrolled in health plans through the Marketplace between November 1st and December 4th. In Wyoming, nearly 14,000 new and returning consumers enrolled during that time.

Caleb Smith, marketing director with Enroll Wyoming, said those who want coverage starting January 1st must enroll by this Sunday, December 15th.

“This deadline is something that we ask people to be mindful of so they can hopefully avoid a gap in health coverage. I’d hate for people to delay action or just forgo trying to get medical help just because they weren’t covered,” he said.

Open enrollment runs until January 15th. But those who wait until the last month to sign up won’t be covered under their new plans until February 1st.

Smith added some Wyoming families are surprised at the discounts they qualify for following pandemic-era increases to advanced premium tax credits. Enroll Wyoming can help anyone navigate the Marketplace, whether they’re enrolling for the first time or if they’ve done it before.

“I certainly know a number of people, they’ve done this a couple times,” he said. They just appreciate somebody kind of looking over their homework to go like, ‘Yeah, you got it.'”

Wyomingites can quickly be connected to a navigator by dialing 2-1-1.

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Nationwide, Black women face a maternal mortality rate three times higher than white women.

To address the disparity, the Maternity Care Coalition is providing doulas to women in underserved rural areas in Pennsylvania.

Jamiylah Miller, doula program manager for the coalition, said its doula and lactation program supports families from pregnancy to three months postpartum, helping during labor and delivery, pain management and adjusting to a newborn.

However, some families who are not connected with a doula through community organizations like theirs, struggle with the cost of doula services. Recent legislation extended Medicaid coverage to help offset the cost.

“The cost varies depending on the doulas private rates, and some of those can be in the thousands,” Miller explained. “We’re learning that a lot of the families who need support from a doula, or who would benefit the most, are those who can’t afford those prices. “

Miller noted their doula services are free to expecting families in the community. She advocated for more organizations to provide doula services to families facing financial barriers.

Miller pointed out their network of 116 doulas, including 29 certified in Pennsylvania, are independent contractors who bring specialized expertise to their services. The organization also offers doula and lactation community health worker training for those interested.

In anticipation of the growing trend of insurance reimbursement for doula services, which began earlier than expected in February 2024, they have been proactively expanding the program.

“We offered both our current doulas that are in our network, as well as our training doulas to become state certified,” Miller emphasized. “We’ve been able to support them in getting all the components of the application that they need, including CPR training, HIPAA training. We’ve been able to help with the application fees.”

Miller added the coalition offers vital resources to new parents including diapers, wipes, formula, breast pumps when available, and home visiting services. Additionally, they use community resources like Cribs for Kids and the Children’s Hospital of Philadelphia car seat program to support families. They are working to expand language services by recruiting more bilingual doulas to better support diverse families.

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