Doctor’s Fear Cuts to Medicaid Adult Dental Coverage Could Cost More in Emergency Care

Courtesy of the Grand Rapids Press, 7/31/09

Disabled and unable to work, Laurel Gruchow waited Wednesday at Ferguson Dental Center for a decision about whether she would have to pay to have several damaged teeth removed to ward off infection. If she somehow managed to catch a break, she wondered how she would afford about $1,300 for the dentures she would need.

Adult dental coverage is optional under Medicaid, and many states —including Michigan as of July 1 — have yanked such programs to plug budget deficits. Vision, chiropractic and podiatry services also got the ax in Gov. Jennifer Granholm’s executive order.

Gruchow, 51, and her longtime partner, Tony Mendoza, who accompanied her to the dentist, are among 585,000 beneficiaries 21 or older who now have to pay for dental, vision and other services.

The state has 1.6 million people enrolled in Medicaid. Dropping some coverage for those 21 and older will save the state $2.1 million this quarter and an estimated $7.1 million in 2010, with more than $5 million coming from dental services. But some health professionals say taxpayers will pay more in the long run as people head to emergency rooms for oral health problems. That’s what happened when services were cut in 2003, they said. The benefits were restored in 2005.

Kevin Kooiker, a dentist at Ferguson, said poor oral health can lead to difficulties in controlling chronic diseases such as diabetes, and a correlation exists between gum disease and heart trouble.

“If or when they do reinstate coverage, we’re going to see a backlog of patients requiring more extensive treatment,” he said. “That will consume a lot more dental time and a lot more taxpayer dollars.

“For now, emergency rooms will treat oral conditions that could have been prevented.”

Ferguson Dental Center is affiliated with Cherry Street Health Services, which provides medical care, dental services, vision care and counseling services. Last year, the center provided 23,000 dental visits to low-income residents of Kent and other counties.

Only dental emergencies — described as severe pain or infection — will be treated. But dentists may only pull, not repair, teeth.

A study by Health Management Associates, in cooperation with the Michigan Health and Hospital Association, found the first six months following the 2003 cuts, oral health-related visits to the emergency room increased 11 percent when compared to the same six-month period the previous year.

Chris Shea, Cherry Street’s executive director, said he’s concerned about health problems from delays in care if the cuts extend through 2010.

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