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State withdraws Medicaid coverage for oral care

Annmarie Dowd, 58, snuggles with her 13-year-old dog, Griz, in her south Spokane home Monday. Dowd had her teeth removed before the first of the year and hopes her application for dentures qualifiesfor Medicaid. (Dan Pelle)
Annmarie Dowd, 58, snuggles with her 13-year-old dog, Griz, in her south Spokane home Monday. Dowd had her teeth removed before the first of the year and hopes her application for dentures qualifiesfor Medicaid. (Dan Pelle)

Nonemergency dental treatment ended Jan. 1 in Washington

Annmarie Dowd had all her teeth pulled a few weeks ago.

Her dentist suggested she hurry up and have the procedure because as of Jan. 1 the state stopped providing Medicaid coverage of nonemergency dental care for adults.

Now the 58-year-old Spokane woman is waiting to hear whether her application for dentures, submitted before the first of the year, will be approved.

Dowd said she is scared.

“When I found out they were getting rid of adult dental, I had it done,” Dowd said, but “I don’t want to be toothless for the rest of my life.”

She said her teeth have been ravaged by medication she must take to prevent her body from rejecting a double lung transplant she received eight years ago.

She is among the at least 105,000 Washington residents, including more than 12,000 in Spokane County, whose dental care will no longer be covered by Medicaid, the state and federal health insurance for the poor and disabled.

On the first workday since the cuts went into effect, public health educator Kay Cobb, of the Spokane Regional Health District, fielded numerous calls from Medicaid beneficiaries asking where to turn for dental care.

“There is nothing for me to tell them to do,” Cobb said. “There is no happy way of looking at it.”

In 2009, Medicaid paid $17.3 million for dental services in Spokane County, according to the Spokane Regional Health District.

While most states provide at least emergency dental services for Medicaid-eligible clients, fewer than half provide the comprehensive services Washington did.

Cutting those will save Washington about $8.3 million through June, but the state will lose approximately the same amount in matching federal funds.

Other budget cuts target adult hearing, podiatry and vision care, as well as school-based medical services and Medicare Part D co-payments. On March 1, the state also will eliminate health coverage for about 27,000 children.

Advocates for the poor say these cuts are penny-wise and pound foolish, and nowhere will this be more evident than in the state’s already overcrowded emergency rooms, the last resort of low-income dental patients in pain.

In Spokane County, the number of emergency department visits for dental problems more than doubled to 4,676 in 2009 from 2,158 in 2005, according to a recent report by the health district.

About 45 percent of those visits were by people who sought dental care in emergency rooms repeatedly over that five-year period, at an average cost of $778 per visit.

Emergency room doctors can do little for a dental patient with an abscess, for example, other than provide painkillers and antibiotics.

The Washington Dental Service Foundation says eliminating coverage for the poor will have a devastating impact on society’s safety net at a time of increased demand.

Among those cut off from dental care will be more than 16,000 pregnant women statewide who could pass cavity-causing bacteria to their infants through saliva when they share food or utensils.

Systemic health conditions linked to inadequate dental care include diabetes, stroke, heart disease and low birth weight, said Rebecca Stolberg, chairwoman of the Eastern Washington University dental hygiene department.

At its Spokane campus the EWU Dental Hygiene Clinic annually treats about 4,700 patients, about 30 percent of whom are on Medicaid. The clinic, which trains future hygienists, charges discounted rates.

“If adults get regular preventive care, it would keep them out of more serious (conditions),” Stolberg said.

Her other concern is that dental hygiene students will not get the experience of caring for Medicaid clients.

“The students need that population and that population needs us,” Stolberg said.

The dental cuts also will significantly impact clinics providing dental care to low-income residents who are unable to obtain dental services through private dental offices.

These safety-net clinics – the Community Health Association of Spokane’s downtown and Maple Street clinics, NATIVE Health and the Spokane Falls Family Clinic – are “overwhelmed and understaffed,” according to the health district report.

Legislators will have the opportunity to restore Medicaid funding for adult dental services in the upcoming session. However, the cuts will have to be weighed against the loss of many other social services after voters rejected increased taxes and made it more difficult to raise revenue in the future.

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