The Sjögren’s Foundation has been working long and hard over the past year to obtain dental coverage for Sjögren’s and other autoimmune disease patients under Medicare. Despite the Foundation’s and our patients’ phenomenal efforts, the Centers for Medicare and Medicaid Services (CMS) has decided it cannot provide coverage under its current mandate. While disappointed, we are pleased that CMS heard our plea and publicly addressed and embraced the oral-systemic connection in Sjögren’s and related diseases when it released its July 14 ruling.
CMS opened the door for the first time last November to considering medically necessary dental care under Medicare when it issued its CY2023 Physician Fee Schedule. The Sjögren’s Foundation leapt at the opportunity to chair the Autoimmune Diseases Working Group in partnership with the Oral Health Consortium to ensure the voice of Sjögren’s patients was heard. Our request for coverage was submitted to CMS in February. This and subsequent presentations to CMS and federal legislators highlighted data, clinical evidence, and compelling patient stories, which drove home the urgent need to expand dental coverage to this population of Medicare beneficiaries.
In its CY2024 ruling, CMS stated that its current view of the restrictions around Medicare coverage for dental services means stakeholders must establish an inextricable link between dental services and the success of an already covered Medicare service. An example of eligible coverage under this view would be for dental care before undergoing joint replacement surgery.
While the latest ruling is a setback for all of us, we should all be proud of our efforts to engage policymakers across Congress and the Administration as well as highlighting the need to expand dental coverage under Medicare to the autoimmune disease population. We are deeply grateful to those of you who responded to our Action Alert by contacting legislators, joining Foundation staff in meeting with some of these offices, and providing personal stories to illustrate our clear need for dental services in Sjögren’s. Together, we clearly succeeded in increasing awareness of the needs of Sjögren’s patients among policy officials, and we are building support for the future.