11/20/2007
Dental community reacts to Governor's announcement eliminating Medicaid funding restoratio

Some dentists say they will be forced to cut critical services to Medicaid patients

COLUMBUS, Ohio – As Ohioans prepare to celebrate Thanksgiving, Ohio's poorest citizens will be facing a loss of access to dental services, due to an announcement this week that the Governor has postponed reinstatement of full funding for Medicaid's adult dental care program.

"The OSU College of Dentistry is one of the largest Medicaid providers in the city of Columbus and the decision not to restore adult dental services to the Medicaid program means more vulnerable citizens will go without care," said Dr. Henry Fields, President of the Ohio Dental Association and former dean and current section head of orthodontics at the Ohio State University College of Dentistry. "Additionally, students in the dental college will be denied training opportunities for treating underserved populations in a culturally competent manner," Fields said.

"Massachusetts learned an important lesson when it eliminated coverage of most dental services for adults," said David Owsiany, Executive Director, Ohio Dental Association. "The number of private dentists actively treating patients declined, and the dental directors at community health centers didn't have the capacity to deal with the large numbers of new patients."

According to a September 2005 report by the Kaiser Commission on Medicaid and the Uninsured, one Massachusetts community health center director estimated that there were typically 80,000 people waiting for 10,000 open dental appointments.

"I fear that's what's going to be happening here in Ohio," said Owsiany. "One day after the Governor's announcement, we're already getting calls from dentists telling us that they are going to have to significantly reduce or stop seeing Medicaid patients altogether to remain in business. And, those dentists practicing in areas where the population is largely Medicaid patients may not be able to keep their doors open, eliminating access to dental services for children and adults in those areas of the state."

The report also states that another lesson learned in Massachusetts is "that the dental benefit reductions resulted in savings of less than one percent of the state's share of total program spending. It appears that some dental costs were shifted to other areas and that untreated dental problems have contributed to an increase in overall medical costs." The Ohio Dental Association warned that the same thing will likely happen in Ohio.

"While we understand the financial pressures facing the state's Medicaid program, this is a penny-wise, pound foolish decision and will no doubt save the state very little money in the short term," Owsiany said. "In fact, this decision will likely cost the state more in the long term, as Medicaid patients seek solutions to their critical dental problems through emergency room care, where examination and treatment of oral pain and infection can cost Medicaid several hundred dollars more than a visit to a dental office, where the underlying problem can be resolved."

"The announcement is disappointing. Many patients have made the difficult choice to postpone root canals, oral surgery and other treatments until the first of the year so the services could be covered," said Dr. John N. Kramer, Martins Ferry dentist and Medicaid provider, "these patients have been living with dental pain and now won't know where to turn."

Dentists already donate hundreds of hours and millions of dollars in treatment to help meet what the Ohio Department of Health has called the number one unmet health care need in the state. The Ohio Dental Association works with dentists across the state to provide free and low-cost dental services to Ohioans who need it most through the Ohio Smile Network. Through this network, Ohio dentists have treated thousands of patients and donated more than $40 million in care and services every year.

Support for Full Funding of Medicaid's Adult Dental Services

Ohio's dental community is not the only group underscoring the importance of fully funding Medicaid's adult dental program. Consider these statements:

The only way to control costs is to get patients treatment in the most effective and efficient settings. The elimination of treatment options like dental care for adults hinders real care management and in the end will cost the state more money.

Bill Ryan, former Director of Medicaid and Director of the Department of Health, Testimony before the Ohio Commission to Reform Medicaid, April 20, 2004

It is really foolish [for states not to] provide those preventative and acute care programs for adults, because some of the most expensive conditions are exacerbated by oral health problems.

Shelly Gehshan, National Conference of State Legislatures

Eliminating dental coverage in Medicaid can lead to higher costs in other parts of the Medicaid budget because, as patients' dental problems worsen and become more acute, some eventually seek care in hospital emergency rooms. Emergency rooms provide care in a much more costly fashion than dentists' offices and may offer poorer quality care than dental facilities.

Center on Budget and Policy Priorities, 2002

Lack of prevention, delayed treatment and the inability to obtain dental examinations often result in avoidable restorative work, and dental work that is performed in emergency rooms or inpatient hospital placements that could have been handled in an earlier state in a general dentist's office. According to one authority, for every $1 spent on preventive care, about $4 is saved in dental costs.

Minnesota Department of Human Services, Dental Access for Minnesota Health Care Programs Beneficiaries: Report to the 2001 Minnesota Legislature