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Dental Care Pulled For Adults On Medicaid

Ruby de Luna
02/28/2011

In January, Washington state cut half a dozen health programs to help close a budget deficit. Among the services to go was dental care for adults on Medicaid. The program will continue for people with developmental disabilities or for Medicaid adults with dental emergencies. KUOW's Ruby de Luna talked to a Federal Way woman who was affected by the cuts.

TRANSCRIPT

Letina Bryan, age 23, has a hole in her tooth. About a month ago she broke a tooth, but was too busy to get it fixed.

Bryan: "And then my tooth started getting bad and I had the worst toothache ever in my life."

So Bryan went to an emergency room. She was offered an injection and a couple of pills to numb the pain. Then she went to NeighborCare Health, a community clinic to take care of her tooth.

Bryan: "And the doctor said, your tooth is really bad. You need a root canal."

Bryan says she has no money to pay for the root canal and cap for her tooth. She's on Medicaid. But last month the state stopped paying for dental care. The program is limited to children, developmentally disabled adults, and dental emergencies.

The hole in Bryan's tooth is patched with a temporary filling. But Bryan has other worries besides her teeth. She's looking for work. She was recently laid off from her job at a department store. She had just moved into an apartment after being homeless for a year. Right now, dental care isn't a top priority.

Bryan: "It was just one of those things that you put on the back of the burner when you are, like, a working mom and you're single. I'm doing this all by myself. It's like you to think about the most important things and the most important thing is to put food on the table and paying your rent."

Washington state has its own hole, a $5 billion budget hole. And dental care is one of the non–essential Medicaid services to be cut this year.

Things aren't likely to change as lawmakers grapple with the budget for the next two years. Proposed cuts to the dental program will affect 105,000 Medicaid clients.

Health care providers worry more people will end up in emergency rooms for their tooth problems, only to find out that hospitals aren't equipped to fix them.

Lieberman: "They don't have the resources or the ability to solve the problem to take the tooth out, or to take the nerve out, or do whatever to take care of the dental pain that's causing the problem."

That's Marty Lieberman. He's the dental director of NeighborCare health. NeighborCare is a local community clinic that provides dental services to Medicaid and low–income people. Lieberman admits it's going to be a challenge to convince lawmakers to restore funding for dental services when other health programs are being cut too. He says eliminating services may save money now. But in effect that's delaying a crisis down the road.

Lieberman: "If we get the problem when it's small, then it doesn't become an emergency, it's a much easier problem to take care of, and it's a much cheaper problem to take care of."

NeighborCare's dental program sees close to 20,000 patients each year, most of them on Medicaid. The clinic also receives state grants to care for uninsured people. Those funds are being cut too. Lieberman says the issue isn't about spending cuts. He says giving poor people access to affordable dental care is just as important as health care.

Lieberman: "We so often separate the mouth from the rest of the body and the bottom line is you can't have overall health if you don't have oral health. There are links that we're seeing to birth weights, cardiovascular disease, respiratory disease, diabetes. Taking away adult dental is going to add to the problem."

Some research shows oral problems like bacteria build–up in the mouth or gum disease can lead to other serious health consequences if left untreated.

Sound: "Hello. This way — "

The state continues to cover dental care for children on Medicaid. That's one relief for Letina Bryan. She's taken her son Akeelys for his first dental check up.

Dentist: "Okay, let's take a look. Can you open real big like an alligator, can you say 'ah'?

Akeelys, age 2 1/2, sits still while the dentist checks his teeth and gums. His mother coaxes him. Her efforts to teach Akeelys good brushing habits have paid off.

Dentist: "No cavities, everything looks really good."

And Letina Bryan's tooth problem? It hasn't gone away. She's keeping her fingers crossed that the temporary filling will hold up until she can get it permanently fixed. And if the toothache comes back?

Bryan: "I just have to deal with it or go to the ER and let them drug me all up and go about my business because there's nothing you can do. All I can do is work on school, get a better job so I can get better medical."

She hopes to get better health coverage to take care of the hole in her tooth — and 12 cavities that were found at her last dental exam two and a half years ago. Bryan hopes to find a hotel job and plans to go to school to complete her GED.

I'm Ruby de Luna, KUOW News.

© Copyright 2011, KUOW

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