Bill Text: HI HB2249 | 2020 | Regular Session | Amended
Bill Title: Relating To Medicaid Benefits.
Spectrum: Partisan Bill (Democrat 19-0)
Status: (Engrossed - Dead) 2020-03-05 - Referred to CPH/HMS, WAM. [HB2249 Detail]
Download: Hawaii-2020-HB2249-Amended.html
HOUSE OF REPRESENTATIVES |
H.B. NO. |
2249 |
THIRTIETH LEGISLATURE, 2020 |
H.D. 2 |
|
STATE OF HAWAII |
|
|
|
|
|
|
||
|
A BILL FOR AN ACT
RELATING TO MEDICAID BENEFITS.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that oral disease is a significant health problem among many Hawaii residents, affecting their overall health and well-being. Since 2010, Hawaii has received a failing grade of "F" in three oral health report cards published by the Pew Center on the States due to multiple policy and systems issues in the State that have left the oral health of Hawaii's families and children in a state that is worse than the rest of the nation.
Access to regular oral health care varies greatly across the State, with rural and neighbor island residents and low-income families experiencing greater access issues. Currently, approximately 180,000 adult medicaid beneficiaries are not getting the benefit of early oral disease detection and treatment for better overall health. Lack of access to dental coverage and oral health care is a health and social justice issue that disproportionately affects poor, minor, elderly, and racial and ethnic minority populations.
In 2009, the State terminated all
preventative and restorative dental care services for adult medicaid recipients
and replaced these services with emergency room services that are limited to
pain relief, injuries, trauma, tooth removal, and extraction. Nationally, studies have shown that reducing
or eliminating medicaid adult dental benefits has led to significant increases
in dental-related emergency room visits and associated costs. In 2012, Hawaii medicaid paid $4,800,000 for
1,691 adult emergency room visits for preventable oral health problems,
according to the department of health's Hawaii Oral Health: Key Findings
report.
The legislature further finds that in
Hawaii, a disproportionate number of adult medicaid beneficiaries ages twenty-one
and older utilize emergency dental services. While these adult medicaid beneficiaries are twenty-five
per cent of Hawaii's population, they represent fifty-six per cent of all
emergency dental services. Just over three
thousand emergency room visits for acute oral health conditions occurred in
2016, totaling more than $17,000,000 in direct costs, a total that has more
than doubled since 2007. Data also indicated that rural residents of the State, primarily
from the north shore of Oahu and the islands of Kauai and Hawaii, were more
likely than urban residents to go to the emergency room for dental problems.
The lack of preventative and restorative
dentistry services for adult medicaid beneficiaries increases potential health
care complications and costs for individuals living with diabetes, including
increased incidence of gum disease; difficulty controlling diabetes; and
likelihood of coronary artery disease.
These complications can lead to increased disability and death. For diabetic medicaid beneficiaries, increased
access to dental care could result in a cost savings between $118,000 and
$1,700,000 for diabetic medical care for all beneficiaries, according to 2019
estimates by the Healthy Policy Institute of the American Dental Association.
The legislature also finds that for
pregnant adult medicaid beneficiaries, ensuring good oral health during
pregnancy may reduce pregnancy complications such as pre-eclampsia, premature
birth, or low birth weight babies. The
average cost of services for the birth of a healthy newborn is approximately
$5,000. In contrast, the cost of services
for a premature or underweight newborn can range from $200,000 to $2,000,000.
Poor oral health is clinically proven to have
serious adverse impacts on overall health and well-being. It is linked to an array of acute and chronic
health conditions including heart disease, diabetes, stroke, depression, low
birth weight, and premature birth. Tooth
decay is almost completely preventable.
However, preventive services, early diagnosis, and interventions that
can halt or slow the progression of most oral diseases is currently unavailable
to adult medicaid beneficiaries in the State. Problems that could have been addressed early,
or even prevented, continue to progress, leading to poor health outcomes and
lower quality of life.
Dental care coverage is positively
associated with access to and utilization of oral health care. Research indicates that children and adults
with dental coverage are significantly more likely to seek and use regular
dental services than those who are uninsured.
Individuals enrolled in medicaid have an
increased likelihood of disparities in health care outcomes based on income. The prevalence of dental disease and tooth
loss is disproportionately high among low-income populations. Insufficient coverage or access to care often
further disadvantages medicaid recipients, driving poor health outcomes and
higher costs.
The legislature additionally finds that expanded
adult dental benefits can have tremendous positive impacts on state medicaid
populations. Individuals with dental
benefits are forty-two per cent more likely to have an annual dental checkup
than individuals who do not have coverage.
Parents who receive dental care are also more likely to take their
children to the dentist as well.
Medicaid provides federal funds for health care
coverage to eligible individuals with low incomes, including children and their
parents, pregnant women, the elderly, and persons with disabilities. The federal government will match up to fifty
per cent of a state's investment in reinstating preventative and restorative
dental benefits for adult medicaid beneficiaries.
Although comprehensive dental coverage is
mandatory for children enrolled in medicaid, dental benefits for medicaid-eligible
adults are optional. Currently,
thirty-four states offer comprehensive or limited preventive and restorative
benefits to adults on medicaid.
The
legislature further finds that expanding dental services benefits for the State's adult medicaid
enrollees will reduce the number of acute oral health-related emergency room
visits and improve these individuals' chronic disease risks and overall health
status. Current estimates are being
developed by the department of human services MedQuest division to determine
the costs of restoring expanded benefits to adult medicaid recipients in
Hawaii.
It has been more than a decade since the
State removed all but emergency medicaid adult dental benefits. The legislature finds that it is in the best
interest of the State and its residents to expand access to care by restoring
dental benefits to adult medicaid enrollees.
Accordingly, the purpose of this Act is to
appropriate funds to restore diagnostic, preventive, and restorative dental
benefits to adult medicaid enrollees.
SECTION 2.
There is appropriated out of the general revenues of the State of Hawaii
the sum of $ or so
much thereof as may be necessary for fiscal year 2020-2021 to restore
diagnostic, preventive, and restorative dental benefits to adult medicaid
enrollees; provided that the department of human services shall obtain the
maximum federal matching funds available for this expenditure.
The sum
appropriated shall be expended by the department of human services for the
purposes of this Act.
SECTION 3. This Act shall take effect on December 31, 2059.
Report Title:
Adult Dental Benefits; Medicaid; Appropriation
Description:
Appropriates funds to restore diagnostic, preventive, and restorative dental benefits to adult Medicaid enrollees, provided DHS obtains maximum federal matching funds available. Takes effect on December 31, 2059. (HD2)
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.