BOISE – More than 42,000 poor or disabled Idahoans lost their non-emergency dental coverage last Friday due to state budget cuts, and there’s some question about whether the state’s expected $1.7 million in annual savings really will pay off in the long run.
”Some of this stuff, if you don’t take care of it at a certain level, then it gets worse, so it can cost a lot more (in the future),” said Dr. Jack Fullwiler, a longtime Coeur d’Alene dentist and current president of the Idaho State Dental Association.
Washington made a similar move six months ago, but it exempted from the cuts patients with developmental disabilities and those in long-term care. In Idaho, all adults on Medicaid will lose non-emergency dental coverage except pregnant women.
Fullwiler said Idaho dentists were relieved that the cuts didn’t go even further. “At least we got the emergency programs for the adults,” he said.
Idaho cut $34 million from its Medicaid program this year, including the dental cuts, new co-payments, and big new assessments on hospitals and other care providers.
“In some of these cases, what they’re doing is cost-shifting,” Fullwiler said.
Cutting dental coverage for adults on Medicaid will put more stress on the few federally qualified clinics in Idaho that charge fees on a sliding scale, he said. “What happens is they get booked out so far that it’s hard to get in,” he said. But, “The people have to be seen. You can’t leave someone in pain.”
Fullwiler said he has Medicaid patients with disabilities he’s been seeing for as long as 25 years; they’ve lost their benefits, but he plans to continue to care for them for free. “You just have to take care of some people,” he said. “A lot of this ends up being picked up by the dentists.”
Idaho’s Department of Health and Welfare has taken about 50 calls on the dental cuts in recent weeks, and even more on cuts to optometry services, including glasses; only conditions related to chronic disease are now covered for optometry. Idaho’s Medicaid cuts that took effect Friday also eliminated podiatry services unless they’re related to chronic disease, and cut chiropractic coverage to six visits a year instead of 24.
Washington eliminated hearing and vision hardware for adults; outpatient physical, occupational and speech therapy; and more, in addition to its adult dental-care cuts.
“No one that I’m aware of was arguing these were a good thing or these were superfluous services that wouldn’t be missed,” said Jim Stevenson, spokesman for Medicaid in Washington. “I think people realized from the start they were extremely serious.”
But as in Idaho, two-thirds of Washington’s Medicaid clients are children, and cuts to children’s coverage are restricted by federal law. “We’re left with really a handful of optional services,” Stevenson said. “Those were the only things that could be cut, and those were the things that were cut.”
In 2008, 29 states offered at least some non-emergency adult dental coverage in their Medicaid programs; only six offered none, and 16 offered emergency coverage only. A 2008 report from the National Academy for State Health Policy said the trend showed “an increasing recognition of the importance of oral health to overall health.”
But since then, at least nine states, including Idaho and Washington, have considered doing away with it; both Idaho and Washington have offered the coverage since at least the 1980s.
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.
Now, Fullwiler said, “I know they’re not going to pay for dentures. They’re going to pay for toothaches, basically.”