Legislative budget writers this morning are delving into the details of Health & Welfare programs, starting with the divisions of welfare and Medicaid. Medicaid takes up 80.6 percent of the budget request for the state Department of Health & Welfare for the coming year, down from 81.4 percent in the current year, fiscal year 2014. Medicaid administrator Paul Leary noted that the pie chart showing that is nicknamed the Pac-Man chart, but, “The Pac-Man is getting smaller, which really speaks to bending the growth curve.”

The department’s request for Medicaid for fiscal year 2015 totals $496.4 million in state general funds, a 4 percent increase, and $2.047 billion in total funds, a 1.1 percent increase. The governor is recommending $484 million in general funds, a 1.4 percent increase, and $2.042 billion in total funds, a 0.9 percent increase. The biggest differences are that Gov. Butch Otter would offset $10.9 million in general funds from a new dedicated health care assistance fund coming from cigarette tax funds, and that the department requested $1.4 million in general funds, which would bring in $3.5 million in federal matching funds, to restore adult dental benefits that were cut during the recession (a total of $4.9 million). Otter didn’t recommend the funding, though he backed restoring the benefit; he recommended drawing on savings from a recent renegotiation of the 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.

The dental coverage was cut in 2011; about 27,000 adults lost coverage. Since then, the Medicaid program’s costs for dental-related emergency room services have more than doubled, from $30,000 a month in 2011 to $65,000 a month today. In just one case, sepsis caused by an abscessed tooth resulted in $300,000 in medical costs that could have been avoided.

“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.