TennCare proposes offering dental coverage to just about everyone in its program

Tennessee is trying to improve oral health. But which comes first: more dentists or more patients with dental coverage? It’s a classic chicken and egg problem. So state leaders are trying to expand both at once.

Tennessee is one of the few states that still doesn’t offer dental coverage to everyone on Medicaid, known locally as TennCare. And poor oral health has all kinds of ripple effects to broader health where the state ranks poorly — like higher rates of diabetes and depression.

“We also know that we have a lot of visits to the emergency room,” says TennCare Director Stephen Smith.

The state spent $10 million in 2019 on patients showing up to the hospital all because of tooth pain or another oral health crisis, Smith says. Many times, hospitals can only offer pain medication — often, opioids.

Under this expansion, first proposed during budget hearings last fall, TennCare would receive another $75 million to provide standard dental coverage to all adults. Children and enrollees with a disability have been covered, and this year, pregnant people were also added. But this expansion adds considerably more than previous expansions — more than 600,000.

This spending would occur prior to any money freed up by the controversial block grant program approved under the Trump Administration. Smith says the universal dental benefit should alleviate some fears.

“There was a lot of talk by the opponents, they said, ‘Well, this is going to result in cuts to people who are served; it’s going to result in cuts to benefits.’ And it’s actually just the opposite,” he says.

TennCare would also pay dentists more to see patients, Smith says.

The expansion is an outgrowth of the Healthy Smiles Initiative. The leadership committee was led by representatives from dental schools and professional associations.

Adding so many new patients at once presents a health care workforce problem. The state is already short hundreds of dentists because class sizes haven’t expanded with the state’s population, says Dr. Lisa Piercey, the state’s health commissioner.

So the Tennessee Department of Health plans to spend nearly $94 million over the next five years to help the University of Tennessee and Meharry Medical College expand their dental programs. Roughly a third of the money will also go to loan forgiveness for students who commit to working in underserved areas after graduation.

“There are only a handful of counties in this state that actually have an adequate number of dentists, so it’s almost every county in the state,” Piercey says, adding that rural counties will be the highest priority. The few dentists in smaller counties are often at retirement age, she says.

The oral health investments have the backing of Gov. Bill Lee and are part of his budget proposal. But the Tennessee General Assembly still has to sign off.