The United States (US) government defines neglect of children as the failure of a parent or guardian to provide necessary food, clothing, shelter, medical care or supervision. Interestingly, the legal responsibility is to the individual and not to an institution or organization. Yet, by it’s own definition of neglect, the US government may have neglected many American children by hindering their right to oral healthcare services.
One of our recent studies found that 215,073 American children go to a hospital emergency room (ER) with a dental problem each year – is this reasonable? Medicaid was supposed to protect children and ensure equity in spite of their parents’ limited financial resources. Are we okay with the fact that the most vulnerable people, children, cannot find care in a regular setting and have to attend an ER for dental care – a place notoriously inefficient at managing dental problems? In fact, ER visits rarely meet the dental need of patients – 96% of patients going to the ER for a dental problem require a subsequent visit with a dentist.
Although Medicaid is supposed to protect our most vulnerable, the Affordable Care and Patient Protection Act (ACA) has stopped short of mandating dental insurance – it only mandates that dental insurance must be offered. However, the most vulnerable populations are also the least educated and have the lowest health literacy. These groups often choose not to take the dental coverage. Additionally, ACA has allowed the states to choose their own implementation plans and, for example, the state of Utah has chosen to exclude routine and emergency dental care – they only permit prevention. Ummmm, okay Utah.
Three-quarters of the children who attend an ER with a dental problem were from areas where mean household income was less than $49,000. Abraham Maslow (1943) was a psychologist who identified a hierarchy of needs. Maslow’s theory suggests that when the lower level needs are not met, individuals are not likely to consider higher level matters to be necessary. For example, if you’re worried about your safety because you live in an unsafe suburb, you are not likely to worry about seeking a dental examination for your child who is not complaining about any pain. Subsequently, the failure to mandate the coupling of medical insurance to dental insurance leaves the most vulnerable population at high risk of neglect and need for urgent oral health interventions.
The greatest irony in this study is that Medicaid failed to insure every child for routine and emergency dental care, yet it was the major payer when those patients presented to the ER. In the ER it fell under medical insurance (which is mandated). In it’s attempt to reduce expenditure, Medicaid limited dental coverage, however, Medicaid continued to cover those dental problems in the ER.