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After costs balloon, Idaho looks to restore dental services it cut

Tue., Jan. 14, 2014, 5:01 p.m.

The Legislature's joint budget committee holds a budget hearing Tuesday morning on the Medicaid budget. (Betsy Russell)
The Legislature's joint budget committee holds a budget hearing Tuesday morning on the Medicaid budget. (Betsy Russell)

BOISE – When Idaho eliminated non-emergency adult dental coverage under its Medicaid program in 2011, it hoped to save money, but it didn’t.

Instead, emergency room costs ballooned, with dental-related emergency room services more than doubling from $30,000 a month in 2011 to $65,000 a month today. Now, the state is looking to restore the coverage.

“It’s an important reinstatement of services,” said Sen. Dan Schmidt, D-Moscow, a physician who serves on the Legislature’s joint budget committee. He noted that he debated against the cut in the Senate in 2011, saying, “You can save money in your car by not changing the oil, but that’s not the right way to save money.”

Idaho Health and Welfare Director Dick Armstrong said the 2011 cut, which removed dental coverage for 42,000 adults, backfired. In just one case, sepsis caused by an abscessed tooth cost the Medicaid program $300,000 in medical costs that could have been avoided.

Armstrong said the state was desperate to save money in the program when it made the cuts, and didn’t want to cut services to children. “We had to do something,” he said.

Lawmakers had hoped to save $1.7 million by the move.

“I don’t know what the net was,” Armstrong said Tuesday. “All we know is that in the long run, it isn’t a good place to be. Dental health is too important to physical health.” It can be neglected for short periods of time, he said, but, “In the long run, there is no return on investment.”

For next year, the Department of Health and Welfare budget request includes restoring the service for 27,000 adults who now would be eligible.

“Other states that removed dental benefits have seen increases in emergency room services and hospital costs, indicating that the savings found from removing this benefit were short-term in nature and can lead to future utilization costs,” according to the department’s budget request.

The department requested $1.4 million in state general funds next year to restore the coverage, which would bring in $3.5 million in federal matching funds; the total cost is $4.9 million. Gov. Butch Otter didn’t recommend the funding, but did back restoring the benefit; he recommended drawing on savings from a recent renegotiation of the state’s Medicaid dental services contract to restore the coverage.

Paul Leary, Medicaid administrator, said the roughly $5 million savings from the contract renegotiation should easily cover the cost, mainly because of decreased utilization of services.

Sen. Shawn Keough, R-Sandpoint, vice-chair of the joint budget committee, said, “Somehow we’re going to take care of it one way or the other, and the prudent thing to do would be to take care of it where it’s less expensive to the taxpayer.”

She said she expects lawmakers to approve the recommendation; budget-setting for state agencies starts next month.

In 2002, Idaho briefly eliminated non-emergency adult dental coverage under Medicaid as part of budget cutbacks, prompting a statewide outcry after an elderly woman who was denied dentures was told she’d have to gum her food; then-Gov. Dirk Kempthorne and the Legislature restored the benefit the following year.


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