Pennsylvania’s adult Medicaid recipients are facing reduced options for dental care.
Due to state budget cuts, Pennsylvania’s approximately two million Medicaid recipients have been reduced to basic dental care — eliminating root canals, dental crowns, periodontal disease work and limiting the number of dentures a patient can receive. The plan covers checkups, basic cleanings, fillings and extractions.
“Our Medicaid budget is outpaced by only two other states and we have to look at how to keep a (limit) on our spending,” says Department of Public Welfare spokesperson Donna Morgan.
Morgan says dental care is actually an optional service under Medicaid and coverage varies from state to state.
DPW estimates that the change will save $42 million this year.
Temple University Kornberg School of Dentistry Dean Amid Ismail says the cuts in benefits could impact the overall dental health of Medicaid patients.
“Not to provide comprehensive care really limits the outcomes of care — which should be focused on health, rather than just treatment of disease and extraction of teeth,” says Ismail.
“With the selected cuts to the most advanced type of services, we ended up with a situation where we will examine adults, we will fill their teeth and we will extract them, but we cannot replace teeth.”
“There may be a need to rethink how to reduce the program and save money without cutting the capacity to provide care so that people will choose the best outcomes,” Ismail added.
Approximately 40 percent of Temple’s dental patients are adult Medicaid recipients. Ismail says Temple has seen a slight drop in the use of root canal therapy and an increase in tooth extractions due to the cuts.
“Basically the only option they are leaving patients is to extract the teeth once they get to the point to where they need a root canal, or pay out of pocket, which for many people is not an option,” says Dr. Andres Pinto, chief division of Community Oral Health, Penn Dental Medicine.
Pinto noted that the change in Medicaid dental coverage is having a far-reaching impact.
“The impact is pretty big. It’s impacting patients. It’s impacting the way we educate students.”
Pinto says that some insurance companies are also following suit and offering a similar type of reduced dental coverage to their customers.
There may be some recourse for patients who need to have periodontal work done.
Morgan says Medicaid patients who need to have periodontal work can apply to have the procedure covered under a benefit limit exception.
According to Morgan, 7,699 requests for appeals were filed from October 2011 through May 2012. However, only 853 have been approved to date.