State budget crises translate into cuts to oral health care

Medicaid dental benefits for poor adults often end up on the chopping block when states are facing hard times. While they may face barriers getting to a dentist, children are entitled to dental care under Medicaid. Adult benefits are considered optional, and in about half the states, Medicaid covers adult dental care only for pain relief and emergencies, the Kaiser Commission on Medicaid and the Uninsured observed in a June issue brief.

In an Oct. 2 story in the Huffington Post, Daniel Lippman focused upon the painful consequences.

“The cuts have left many poor people with few options to pay for services such as teeth cleanings, fillings and dentures.

“States that have recently slashed funding for adult dental coverage include Pennsylvania, Massachusetts, Illinois, California and Washington.

“In 2007, Washington state was spending more than $30 million annually on its adult dental Medicaid program. In recent years, however, the state has cut those benefits, and in 2011 it axed non-emergency dental care for all Medicaid-eligible adults except those with developmental disabilities, long-term care patients, and pregnant women. Of the 488,000 Medicaid-eligible adults in the state, only 38,000 are still eligible for non-emergency care, according to data compiled by the Washington State Dental Association.

“Cory Curtis, a spokesman for Washington Governor Chris Gregoire (D), said dental coverage was preserved for the state’s ‘most vulnerable adults,’ but that the cuts were made because dental care was “one of the few areas in the Medicaid program that could be reduced.”

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In August, Abby Goodnough, of The New York Times, also reported on the loss of adult Medicaid dental benefits around the country. In Illinois, she wrote, Gov. Pat Quinn decided to cut $1.6 billion out of his state’s $15 billion Medicaid budget, reducing adult coverage to adult tooth extractions.  Also eliminated from the state’s plan were vision chiropractic and podiatry coverage.

And Goodnough found that, under budgetary pressures, Massachusetts stopped paying private Medicaid providers for fillings, root canals, crowns and dentures in July 2010.

The state “recently decided to restore part of that coverage,” she reported.

“Starting in January, Massachusetts Medicaid will pay for fillings – but only for those in the front of the mouth. The reasoning was that healthy front teeth were more important for getting and keeping jobs.

“A lot of folks are out of work,” said Courtney Chelo, coordinator of an oral health task force at Health Care For All, an advocacy group in Boston. “If you have a gap in the front of your mouth because you had a tooth extracted, it’s much more difficult to get a job.”

As far as adult Medicaid dental benefits, the Patient Protection and Affordable Care Act (PPACA) does not offer much relief, according to the June Kaiser report.

While the PPACA promises to extend health care coverage to millions of poor adults, thanks to Medicaid expansion and subsidized coverage bought through new health insurance exchanges “the large gaps in dental coverage will remain largely unaddressed,” the brief concluded.

The PPACA requires “essential health benefits” to be covered by all qualified health plans beginning in 2014 and that requirement extends to Medicaid “benchmark benefits” as well. However, these essential health benefits include dental care for children – but not for adults.

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States do have an option to break with the trend, though. The Obama administration has signaled that states can offer their existing Medicaid package as a benchmark for newly covered adults and states do have the option to include adult dental care in their Medicaid benchmark benefits under the PPACA.

The federal government will pay 100 percent of the cost of the benefits for the Medicaid expansion population from 2014 to 2016 and at a high match rate thereafter.

So are any states considering this option or are more adult Medicaid dental cuts in the making? Is an expansion or a cut in adult Medicaid dental care being discussed by officials in your state?

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