Bill would allow pregnant women on AHCCCS to get dental coverage

For a third straight year, oral-health advocates are pushing Arizona legislation that would give dental care to pregnant women covered by Medicaid.

Supporters say good oral health during pregnancy contributes to healthier babies and may instill dental habits that will help prevent cavities, gum disease and other dental woes.

Adults enrolled in Arizona’s Medicaid program are limited to a $1,000 per year dental benefit for emergency care.

“It is a critical issue that we’ve tried to address in a number of budget cycles and it always has sort of been cut at the last minute,” said the bill’s sponsor, state Sen. Heather Carter, R-Cave Creek.

“I think this has a very good chance this session. I am extremely hopeful,” she said. “It’s one of my priority pieces of legislation.”

Senate Bill 1088 has already received unanimous approval from the state Senate’s Health and Human Services Committee.

Unlike prior years, this year’s version of the bill does not place a cap on how much pregnant women can spend on dental care, giving them leeway to get preventive care as well as more costly dental fixes like root canals, crowns and fillings.

The bill estimates Arizona’s cost of the program at $359,700 from the general fund, plus $818,000 in federal Medicaid dollars for a total of $1.18 million.

Supporters argue that short-term budgetary impacts are outweighed by long-term health benefits.

“Typically, we don’t see this type of legislation pass in the first year. Sometimes it takes two, three, four years,” Carter said. “Since I’ve been serving in office this is a topic we have talked about year after year after year and I feel we’ve reached critical mass.”

The bill, if passed, could have a significant impact on the health of Arizona families.

According to the most recently available data, more than half of all babies born in Arizona are born to mothers covered by Medicaid, which is a government insurance program for low-income people. Currently, 18,400 pregnant women are enrolled in the Arizona program.

“Oral health is critical during pregnancy,” Carter said.

Many health experts are increasingly tying oral health to overall health, including linking gum disease in moms to premature babies.

The bacteria that causes tooth decay is a transmittable disease that can be passed on from mom to baby, said Kevin Earle, executive director of the Arizona Dental Association.

Covering preventive dental care for pregnant women is also a way of educating women about oral health, he said.

“We want to make sure that we’ve got moms taken care of and passing along good oral health habits to their children,” Earle said. “We are hoping the third time is the charm.”

Tooth decay remains the most common chronic health condition in childhood, the U.S. Centers for Disease Control and Prevention says. More than half of Arizona’s kindergarten children — 52 percent — have tooth decay, which is higher than the national average of 36 percent, a 2016 report from Arizona’s First Things First says.

Periodontal disease, mainly the result of infections and inflammation of the gums and bone that surround and support the teeth, is more common in women than men, and among those living below the poverty level, the U.S. Centers for Disease Control and Prevention says.

Risk factors for periodontal disease include female hormonal changes that accompany pregnancy.

A bill introduced by then-Sen. Kimberly Yee, a Republican from Phoenix who is now Arizona’s state treasurer, failed during the most recent legislative session. At the time, Yee said the bill’s failure was due to prioritizing teacher raises last session, not from a lack of support.

Another issue raised when the bill was considered last session concerned the secondary costs of the program.

The “pregnant” category of AHCCCS has a less favorable formula of federal matching funds than the regular population, and a Joint Legislative Budget Committee analysis said the benefit could result in more pregnant women on AHCCCS seeking prenatal care.

This year’s bill includes language that would appropriate an additional $3.4 million from a state fund that collects prescription drug rebate money for people covered by Medicaid as a backup to cover any additional costs the health program could incur.

Among the bill’s supporters are the Arizona chapter of the American Academy of Pediatrics, the Phoenix-based Children’s Action Alliance, the March of Dimes, the Arizona Hospital and Healthcare Association and the American Congress of Obstetricians and Gynecologists.

When the Senate’s health committee considered the bill, committee member Sen. Tyler Pace, R-Mesa, pointed to varying results in studies associating dental problems in pregnant women to premature babies.

“There’s competing research on this,” Pace said.

Pace ended up voting for the bill but said he still has a concern about whether it will actually improve the health of newborns in Arizona, and he’d like to see the data once the program starts. If the state is adding a service to AHCCCS, it should produce results, he said.

Unlike previous legislation, the current bill puts no annual cap on how much pregnant women can spend on dental care.

“We, in consultation with Sen. Carter, thought it ill-advised to put a cap on it,” Earle said. “The cost of the benefit is relatively minimal. The thinking was if an expectant mom needs dental care, the cap would be an impediment to getting the right kind of care.”

Some oral health advocates, including Earle, see the coverage for pregnant women as a step toward eventually getting comprehensive dental coverage for all adults enrolled in the Arizona Health Care Cost Containment System. oral