Idaho re-examines Medicaid dental cuts

BOISE – When Idaho eliminated nonemergency 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 nonemergency dental coverage for 42,000 adults, backfired. In one case, sepsis caused by an abscessed tooth cost the Medicaid program $300,000.

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 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 recommend restoring the coverage, drawing on savings from a recent renegotiation of the state’s Medicaid dental services contract.

Paul Leary, Medicaid administrator for the state, 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.