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Washington Medicaid increases dental coverage for adults

In her private practice office, dentist Ashley Ulmer fits new dentures on Steve Jaimz, a patient at the Inland Dental Expanded Access Clinic, on Tuesday. Ulmer is director of the IDEA Clinic, which sees low-income and Medicaid patients in need of dental care. (Colin Mulvany)
By Jim Camden jimc@spokesman.com(509) 879-7461

OLYMPIA – A quarter-million adults in Washington will gain dental coverage over the next two years as the state expands its Medicaid rolls under the Affordable Care Act and re-establishes programs dropped in budget cutbacks.

Starting Jan. 1, current Medicaid recipients who lost coverage after successive rounds of budget cuts in 2009 and 2011 will have it restored, and those added to the health care program under an agreement between the state and federal government will also be eligible for dental coverage, state officials said.

“Obviously, it’s a relief,” said Dr. Ashley Ulmer, a Spokane dentist who has a North Side private practice and serves as director of the Inland Dental Expanded Access, or IDEA, Clinic. “Some people have put off care for a long time.”

Children in Medicaid families in Washington never lost dental coverage, said MaryAnne Lindeblad, the state Medicaid director. In recent years, though, legislators whittled back coverage for more than 100,000 adults, to the point that most were limited to emergency procedures such as pulling teeth that were painful, infected or impacted, often after a patient showed up at an emergency room.

In agreeing to expand Medicaid under the Affordable Care Act – or Obamacare, as many people call it – the Legislature this year set aside $23.3 million for this biennium to restore dental coverage to adults, Lindeblad said. But it will receive $49.2 million from the federal government to cover newly eligible families.

“With the pent up-demand, it may be problematic, out of the gate, to get an appointment,” she said. “We’re going to watch to see if we have capacity issues.”

Bracken Killpack, vice president of government affairs for the Washington State Dental Association, said the state has among the highest ratios of dentists to population in the country and should have the capacity to handle the increase. It helps that, unlike medical practices, where specialists outnumber general practitioners, about 80 percent of dentists are in general or family practice, he said.

But some dentists initially may be reluctant to take new Medicaid patients after their experience with the state starting, stopping and restarting coverage over the last decade, he added.

“They’re going to be a little cautious,” Ulmer agreed. Some patients were in the middle of treatment programs when they lost their coverage, and dentists scrambled to work out reduced fees or payment plans that could fit with patients’ limited resources. Adult dental care is often more complex and expensive than children’s care, and reimbursement rates from Medicaid are lower.

Not everyone who is covered by a Medicaid dental program will use it, Ulmer said, just as not everyone who has private dental insurance uses it until there’s an emergency. But the goal is to get as many people in preventive care as possible.

The IDEA Clinic will treat adults on the new Medicaid programs as well as those who don’t have insurance, essentially “everybody who comes through the door,” she said. Spokane dentists volunteer their services, but the clinic still has overhead and staff costs, and the reimbursement rates will help with that.

“We might be able to break even with Medicaid,” Ulmer said.