Circuit court judge reinstates Medicaid for adult dental care

ST. LOUIS -- A St. Louis circuit judge has ruled that the state of Missouri erred when it denied adult dental benefits to more than 320,000 low-income Missourians.

Judge Timothy Wilson ruled Wednesday the state budget cut -- effective July 1 -- that eliminated all adult dental services for Medicaid recipients violated state law. Wilson's ruling said the law requires the Missouri Department of Social Services to provide dental care.

Attorney Thomas E. Kennedy and John Ammann, director of the Saint Louis University Legal Clinic, filed a lawsuit seeking to restore the benefits on behalf of three people. The lawsuit's plaintiffs, all St. Louis residents, are Lloyd Edward Smith, 36; Betty Brent, 45; and Serveller McNeil-Terry, 53.

"It's an excellent ruling," Ammann said Thursday. "Judge Wilson gave a very well reasoned decision. It has had an impact on more than 300,000 Missourians.

"The people it applies to are hardworking St. Louisans and Missourians. They are, for the most part, working minimum wage jobs and don't have insurance benefits. They can't afford these dental services. These services have been provided by the state along."

Funding withdrawn

About 88,000 Missourians took advantage of the benefits in 2001, before Gov. Bob Holden and the Legislature withdrew funding to help balance the budget this year. Facing shrinking revenue, Holden and lawmakers approved a state budget without $4.6 million for the Medicaid program.

The cut funds represented the expected cost of providing dental care to adult Medicaid recipients. Holden recommended the cut as a way to help balance the budget. The benefits expired at the beginning of July.

Wilson's 20-page ruling marks at least a temporary victory for advocates for the poor. Wilson issued a preliminary injunction temporarily blocking the state from halting adult dental services for Medicaid recipients. Kennedy said a final ruling in the case will have to wait until after a trial can be held.

The Missouri Department of Social Services wasn't prepared to discuss the ruling on Thursday.

"We have not received the judge's decision," said Christine Rackers, associate director of the Department of Social Services.

"At this time, we're not prepared to discuss it. Our attorneys will have to read it and we'll make a statement at that time."

Smith is a developmentally disabled man with a job in a sheltered workshop. Kennedy said Smith is unable to arrange dental or medical coverage for himself, a service he is now getting from the Life Skills Foundation. The group offers residential services and other help for the developmentally disabled.

"That foundation provides these services for a lot of people, and they are going to be overwhelmed," Kennedy said.

As for Smith, "Without these dental benefits, his independence is going to be threatened."

Brent has multiple sclerosis, diabetes, hypertension, and a back injury.

He said McNeil-Terry also needs immediate dental attention. She is on a waiting list for a kidney transplant, and to stay on the list she needs a clearance form that says she has good dental health.

The lawsuit named Dana Katherine Martin, director of the Missouri Department of Social Services, as the defendant.

The suit sought an order requiring Martin to restore dental benefits for adults in the Medicaid program. Funds to pay for extractions, filling cavities, root canals, treating gum disease and preventive care were eliminated in the budget cut.

Kennedy cited a state law regarding Medicaid that says benefits for dental care "shall be made on behalf of eligible needy persons."

The judge agreed with Kennedy.

"We were confident about the cause," Ammann said. "We believed from the beginning the state's need to balance the budget should not allow it to violate the law. There's a state law that says dental services have to be provided. The state can't simply say we don't have the money this year and we can't do it.

"Under the judge's ruling, these people can get their full range of dental services."