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Informing Policy. Advancing Health.

Legislators Debate New Oral Health Policies

April 22, 2013

Oral health has emerged as something of a theme this legislative session, and last week we saw two noteworthy oral health bills make progress.

The first, SB-242, would add a dental benefit for adults covered by Medicaid insurance. Currently, children with Medicaid coverage can receive dental services, but Medicaid adults are reimbursed only for emergency dental care.  This bill proposes transferring money from the Unclaimed Property Trust Fund to pay for the new benefits, which would go into effect by April 1, 2014. The bill passed the full Senate on a 21-14 vote, with Senator Larry Crowder (R-Alamosa) providing the sole Republican vote. The legislation is being sponsored by Senator Jeanne Nicholson (D-Gilpin County).

Proponents of the bill highlighted the importance of oral health and the critical role of preventive dental care in averting costly emergency services. For example, a report from the Pew Center on the States found that preventable dental conditions were the primary diagnosis in 830,590 visits to emergency departments nationwide in 2009 – a 16 percent increase from 2006.

Opponents were mainly concerned with the cost. The fiscal note estimates that the new dental benefits would increase state expenditures by at least $53 million in FY 2014-15 – more if SB-200 to expand Medicaid eligibility passes – and would require adding two full-time state employees. The money from the Unclaimed Property Trust Fund would cover an estimated $22 million, with the federal government covering much of the rest with matching dollars. In addition, the Hospital Provider Fee would cover about $235,000 in FY 2014-15.  Dental benefits would be capped at $1,000 annually for each Medicaid client. The bill heads to the House, where Representative Dianne Primavera (D-Broomfield) is the sponsor.

The other oral health bill of note is SB-261, which passed the Senate Health and Human Services Committee on a 6-1 vote last week. Also sponsored by Senator Nicholson, it would establish an Oral Health Community Grants program to be administered by the Colorado Department of Public Health and Environment (CDPHE).  The grants would be used for school-based initiatives to prevent tooth decay, such as dental sealant programs, with a particular focus on low-income children. Grants would also be used to fluoridate community water supplies or for other evidence-based programs that promote oral health.

The bill essentially restructures CDPHE’s existing oral health programs, replacing the current dental assistance and water fluoridation programs with one consolidated grants program. The fiscal note assumes that the bill would not require any new state expenditures.

In committee testimony, Senator Kevin Lundberg (R- Berthoud) said his constituents are concerned about the safety and necessity of fluoridated water. He questioned whether the fluoridation of public water supplies was an appropriate role for the government.

Many proponents gave passionate testimony, including representatives from Oral Health Colorado, the Colorado Children’s Campaign and the Colorado Dental Association. Supporters spoke of the evidence showing that optimally fluoridated water can have a significant impact on reducing tooth decay – reducing cavities by as much as 30 to 40 percent, according to some studies. Many also spoke of the prevalence of dental disease among low-income children and the impact that the bill could have in reducing the long-term negative effects of childhood cavities.  No opponents testified at the hearing. The bill is headed to the full Senate for a second reading this week.