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Oct. 10, 2011
TOPEKA Spokesmen for Kansas safety net clinics and other groups today urged state legislators to consider authorizing routine dental care for adults enrolled in Medicaid.
Currently the program only provides routine dental services for children and emergency services for adults. Those emergency services include extractions in the event of acute or chronic infection or in cases of injury so severe the teeth can't be salvaged.
"I believe it's the right thing to do. I believe it would enhance positive health care outcomes. I believe it would transfer responsibility for maintaining good health to the covered individual, and I believe it would save money for the state of Kansas," said David Sanford, chief executive of GraceMed, a Wichita safety net clinic.
The cost of providing routine dentistry for all adults on Medicaid would cost the state about $11 million more a year, with about $4.5 million of that coming from state coffers. The rest would be made up by the federal government. About $40 million was spent on Medicaid dental care in the fiscal year that ended July 1, according to Medicaid Director Barb Langner. The state picked up about $12.2 million of the cost.
Dental care is an optional service for state Medicaid programs, in that the federal government does not require it. The federal government pays about 60 percent of the cost of Kansas Medicaid, a program that provides health coverage for about 350,000 Kansans who are poor children, disabled or elderly.
Kansas once provided dental services to more people on Medicaid.
Between April 2007 and Jan. 1, 2010, the benefits were extended to those ages 21 and older who were receiving home- or community-based services through Medicaid. But that coverage was stopped when Kansas policymakers began cutting budgets in response to the economic downturn.
Members of the Joint Legislative Budget Committee did not seem to favor the idea of expanding services again. Most said they wanted to see evidence that providing more dental care could cut Medicaid costs.
"We all hypothesize that the benefits would exceed the cost, but no one can seem to prove it," said Sen. John Vratil, a Leawood Republican.
Sen. Laura Kelly, a Topeka Democrat, said she liked the idea of a pilot program to test if expanding dental coverage could trim expenses such as those from ineffective visits to hospital emergency rooms because of toothaches.
Chad Austin of the Kansas Hospital Association told the committee that in 2009 and 2010, Kansas hospitals had treated about 17,500 dental problems in emergency rooms when the best course of action for the patient generally would have been a visit to a dentist.
"In many of these cases," he said, "the emergency room staff is only able to provide temporary medical relief through pain medicine and antibiotics. The patient is instructed to seek follow-up care with a dentist and is typically provided a list of dentists in the vicinity."
Committee members also heard testimony from Karlene Ketola, executive director of the Michigan Oral Health Coalition.
Ketola said Michigan was one of nation's hardest-hit states when the economy tanked. Unemployment, at its worst, was 14.1 percent statewide and 30 percent in Detroit, the largest city. Michigan policymakers eliminated the state's business tax, which created a $1.2 billion budget deficit that was partially filled by taxing the incomes of retirees and by adding a 1 percent tax on health insurance claims to finance Medicaid. Through all that, she said, the state had continued to provide routine dental services for adults on Medicaid.
"Even in the toughest of financial times, providing this benefit to pregnant mothers, vulnerable adults and persons with disabilities makes fiscal sense," she said.
Committee members took no action on the proposal. The panel is scheduled to meet again in Topeka on Nov. 14, when it is expected to begin crafting its recommendations for consideration by the 2012 Legislature.