Mo. Medicaid may restore adult dental care

JEFFERSON CITY, Mo. -- Hundreds of thousands of low-income adults appear likely to regain dental coverage through Missouri's Medicaid program, nearly a decade after the benefits were eliminated in a cost-cutting move.

A Missouri Senate panel agreed Wednesday to include an additional $48 million of federal and state money in next year's Medicaid budget for dental care. The House previously approved the same amount.

Although the chambers still must resolve differences about exactly how that money would be spent, support for the dental coverage by both the House and Senate budget committees means it is likely to remain in the final version of the budget, which must be passed by May 9.

Children, along with adults who are pregnant or blind, already receive dental coverage through Missouri's Medicaid program. But general dental coverage was eliminated for most adults as part of a sweeping reduction to the state's Medicaid program passed by the Republican-led Legislature in 2005.

Some Republicans now are leading the effort to restore dental care, arguing that Medicaid recipients are turning to emergency rooms when the pain from toothaches becomes unbearable. They said emergency doctors often can only treat the pain, not the underlying problem, at a cost that is typically higher than if patients had received preventive care.

"This is part of the safety net that we have just completely ignored for the people that are depending on us," said Sen. Rob Schaaf, a Republican physician from St. Joseph who supports the dental coverage.

In 2005, Schaaf was one of the 89 Republican House members who voted to pass legislation cutting adult Medicaid eligibility and benefits, including dental services. Many of those other Republicans who voted for the cuts are no longer in the Legislature because of term limits.

The restoration of dental coverage could benefit more than 300,000 adults enrolled in Missouri's Medicaid program.

Under the House budget plan, the full $48 million would go toward adult dental care through Medicaid. The Senate budget plan would spend $30 million to restore basic dental coverage to adult Medicaid participants, $17 million to increase the rates dentists are paid for treating children and others already receiving Medicaid dental care, and $1 million for regional pilot programs to divert people with dental problems away from emergency rooms.

Once the chambers agree on a final version, the proposed budget would go to Democratic Gov. Jay Nixon.

The governor's budget director, Linda Luebbering, said she would discuss the potential for adult dental coverage with him.

Nixon hadn't included adult dental care for Medicaid recipients when he outlined his budget recommendations in January. But Luebbering said that is largely because the governor was focused on trying to expand Medicaid eligibility to low-income adults who currently earn too much to qualify for the program. That broader Medicaid expansion could trigger about $2 billion annually in federal funds under President Barack Obama's health-care law, but it's not in either the House or Senate budget plan.

A report last fall from the Missouri Department of Health and Senior Services found that the number of emergency room visits for dental complaints by people ages 20 to 44 more than tripled from 1994 to 2011, and many were for diagnoses that could have been treated in a dental office. In 2011 alone, the report estimated that emergency room visits for dental problems resulted in $6.6 million of charges to Missouri's Medicaid program.

"We've seen a lot of wasted money in emergency room services for dental conditions that could be handled much more appropriately through dental offices," said Gary Harbison, executive director of the Missouri Coalition for Oral Health. "So we think the change they have made through the budget is a very good thing."

Democratic Gov. Bob Holden originally proposed to eliminate adult dental Medicaid coverage in 2002 as the state was facing a budget crunch. The Legislature followed his suggestion, but the cut was challenged in a lawsuit by several Medicaid recipients. A federal judge ruled in 2003 that dental coverage could not be eliminated because it was an entitlement under Missouri law.

The 2005 legislation, signed by Republican Gov. Matt Blunt, eliminated dental coverage as an entitled Medicaid benefit for adults. It has not been funded since then.

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