Coverage's end may lead to pulled teeth

JEFFERSON CITY, Mo. -- A decision to end Medicaid coverage for adult dental care has raised concerns about how poor Missourians will receive treatment after July 1.

And the head of the Missouri Dental Association fears there may be a rush by patients to have teeth removed before their benefits end.

While there is no evidence yet to suggest a teeth-pulling rush, "that's the word on the street," said Jake Lippert, executive director of the dental group. "There's no other safety net out there for adults."

Dental care will continue for children covered under the state and federally funded Medicaid program for the poor and disabled.

But Gov. Bob Holden in January recommended the elimination of the adult dental benefit as a way for the state to save money. Lawmakers included the cut in their final version of the budget passed this month.

88,000 used benefit

About 300,000 adults currently are eligible for Medicaid dental coverage, although about 88,000 used the service last year.

Lippert said some Medicaid patients may want to have teeth pulled now in order to qualify later for dentures, which will still be covered when the 2003 fiscal year starts July 1.

Other people may take extreme measures, added Joe Pierle, executive director of the Missouri Primary Care Association.

"It doesn't really make sense for the Medicaid program to pay for dentures and not (tooth) extractions," Pierle said. "There's a real possibility of people doing their own extractions."

Pierle and Lippert said Medicaid patients with serious dental problems could turn to hospital emergency rooms when their traditional dental coverage expires.

"That triples the cost," Lippert said. "The state is going to end up paying the emergency rooms for the service" that dentists previously provided.

In recent years, many Medicaid recipients had complained that few dentists were willing to treat them because the state reimbursed dentists for just 55 percent of their costs.

State officials said they are not aware of a rush on dental treatment before the Medicaid service ends.

But if a person needs to have teeth pulled, news that Medicaid would no longer cover removals may be motivation to act quickly, said Greg Vadner, the state's Medicaid director.

"If you have coverage today for something and you definitely have a medical need to get something done ... there's an economic theory that says a prudent person would take advantage of that," Vadner said.

Gloria Crull, executive director of the Family Health Center in Columbia, said calls from patients increased dramatically when word of the Medicaid dental cut began spreading a few months ago.

"At that point, when the general public became aware of the situation, our phones really started ringing off the hook from individuals covered at the time to make appointments in time to get their coverage," Crull said.

Balancing the budget

Holden said the cut to dental service had to be made to balance the state's roughly $18.9 billion budget.

"We tried to protect those citizens where we could with the funding we had," Holden said. "There are some people unfortunately that got hurt in this process and that's too bad."

Rep. Quincy Troupe, who tried unsuccessfully to keep the Medicaid dental money in the budget, said there was no excuse for eliminating the service.

"That's criminal that people are going to have to get all their teeth pulled because they won't have any dental care. That is barbaric," said Troupe, D-St. Louis. "The budget was balanced on the backs of the helpless."