Will Medicaid Enrollees in Massachusetts Lose Dental Coverage (Again)?

MassHealth (Medicaid in Massachusetts) enrollees who visit their dentist regularly may notice a sense of urgency during their appointments. This is dentists' response to a recent publication from MassHealth, the "MassHealth Fact Sheet-FY11 H2." MassHealth sent the "fact sheet" to dentists, but did not inform the people MassHealth serves. The fact sheet declares an end to most adult dental coverage by MassHealth as of July 1, 2010, the beginning of fiscal year 2011. The fact sheet claims that the state will save $56 million. Scott Davis, Chief Communications Officer of the Massachusetts Dental Society (MDS) and David White, Director, Governmental Affairs and Grassroots Advocacy of the MDS demonstrate that the MassHealth Fact Sheet-FY11 H2 is misleading and works against the best interests of the Commonwealth.

According to Davis and White, the estimated savings are dramatically overstated by the "fact sheet". Over half of that money comes from the federal government. The state will only save about $ 22 million instead of the projected 56. Massachusetts will transfer about half of that or $11 million to the Health Safety Net. This does not account for costs in the form of increased emergency room visits. The rise in emergency room visits is so well documented, that it was cited as a major reason to reinstate adult coverage in the MassHealth dental plan in 2005.

Davis and White indicate that about a third of MDS members (1500) are providers for MassHealth. This is a three fold increase over a few years ago. The MDS "Call to Action" sets a target of two thirds of members or 3000 dentists participating in MassHealth. Annual threats to cut spending on the adult coverage for MassHealth help to maintain a low level of trust among dentists. This uncertainty makes it difficult for the MDS and MassHealth to increase or even maintain enrollment of dentists.

MassHealth cut the adult dental benefit except for emergency care from 2002 to 2006 creating a valuable public health experiment. The hypothesis (what the legislators thought the experiment would prove) was that if the Commonwealth stops paying for oral health care through MassHealth, there will be a net savings of tens of millions of dollars. Additional hypotheses were that there would be little or no political cost for this change, and the people who lost coverage would obtain care some other way. The Kaiser Family Foundation's Commission on Medicaid and the uninsured reports on the results in a 2005 report, "Eliminating Adult Dental Coverage In Medicaid:An Analysis of the Massachusetts Experience."

2001 is a benchmark year in the report. It is the last year before the redaction of the adult dental benefit in MassHealth coverage. In 2001, MassHealth covered a wide range of dental services for adults including dental cleaning, examinations, dentures and fillings. In 2002, MassHealth reduces coverage to include X-rays, extractions and relief of pain. The report compares statistics of 2001 with 2004.

The reduction of the MassHealth dental benefit causes pain and financial hardship for tens of thousands of Massachusetts Residents. The report illustrates how some residents would hold onto infected and broken teeth even when suffering pain and swelling. They fear losing teeth and not being able to afford replacement.

In 2002, the 37 publicly supported dental clinics care for the poor using funds from the free care pool. Unfortunately, the clinics are not able care for the tens of thousands of MassHealth enrollees and uninsured who call for appointments. Dental schools and private dentists can not bill the free care pool. Dental schools are over run by patients who are only able to afford the most basic care even at dental school rates. Private dental offices that previously cared for large numbers of MassHealth enrollees lay off employees. The loss of the MassHealth dental benefit in 2002 creates a hardship for MassHealth enrollees and MassHealth providers.

For voters and legislators, the bottom line is the bottom line. The total cost savings in fiscal year 2004 compared with 2001 on paper is 16.5 million. That is about one percent of the cost of the plan in 2001. The Commonwealth spends much of the savings by supporting the additional costs in the free care pool. The Kaiser report indicated that a lack of dental care contributes to poor overall health; Kaiser predicts increases in medical care costs for these patients. Additionally, many enrollees find it difficult to find employment with unappealing dental conditions which keeps many on welfare who may otherwise be able to work. According to this report, even the small savings is debatable.

Massachusetts reinstated the MassHealth adult dental benefit on July 1, 2006. On that date, most adults with MassHealth coverage do not realize that they have dental coverage. That's convenient as in 2006, the very limited number of private dentists and the small number of public health dental clinics are insurmountable barriers to care for most Massachusetts residents eligible for adult dental care under the MassHealth system. Today, 1500 members of the Massachusetts Dental Society (MDS) are providers for MassHealth.

The "MassHealth Fact Sheet" represents Gov. Patrick's budget proposal. The real budget will come from the state representatives and senators over the next two months. It is time to call your state representatives and senators to explain why MassHealth coverage for adult dentistry is important to you.