Fluoride Action Network

Dental crisis looming in state, experts say

Source: Lansing State Journal | November 24th, 2009 | By Scott Davis
Location: United States, Michigan

Note from Fluoride Action Network: The state of Michigan fluoridates 90.9% of public drinking water.

Jacqui Day hasn’t seen a dentist for a checkup for more than a year.

And she’s bracing herself for the dull, throbbing pain ahead.

One of 400,000 Michigan adults who lost Medicaid dental coverage with state budget cuts in July, the 60-year-old Lansing woman remembers what happened the last time Michigan eliminated the benefit in 2003.

Because Day couldn’t afford dental care, a tooth infection set in, causing complications that resulted in her being hospitalized for days in a critical care unit.

“I almost died,” said Day, who uses a wheelchair because of rheumatoid arthritis. “I’m afraid that people will wind up in emergency rooms (with the new budget cuts) and it’s going to cost a lot more money.”

Mid-Michigan dental professionals are bracing for increased demand at clinics that serve the uninsured. One clinic is already seeing more cases of acute dental problems, such as severe tooth decay or infection, as low-income people forgo routine cleanings.

On Oct. 7, an elderly developmentally disabled woman was hospitalized in Alpena after she said her condition was complicated by a dental infection that went untreated due to loss of the Medicaid benefit. She later died.

“We are extremely concerned,” said Dr. Jaeson Fournier, a deputy health officer who oversees adult dental services at the Ingham County Health Department. “People are coming to see us more when they are in crisis. We’re becoming more of an urgent care center.”

Serving 2,193

The health department has one of the few remaining clinics in mid-Michigan that offers preventive cleaning and tooth fillings to uninsured low-income residents, charging them discounted fees based on income. In the last fiscal year that ended Sept. 30, the department provided dental treatment to 2,193 adults.

Medicaid still covers emergency procedures such as tooth extraction for low-income adults. Since July, the county health department has used part of a $1.3 million federal stimulus grant to cover routine procedures. Children from low-income families continue to receive full dental coverage under Medicaid.

To address a $2.8 billion shortfall, state lawmakers decided to continue the Medicaid cut into the fiscal budget that began Oct. 1 — about $5 million. But advocates say the cut means the state is losing out on $16million in federal funds and will face higher Medicaid costs as more low-income people with acute dental needs end up in hospital emergency rooms.

Trips To ER Rise

After the state cut dental coverage in 2003, health professionals say, emergency room visits rose by more than 10 percent until the state restored Medicaid coverage in 2005.

“The same thing is going to happen this time,” said Dr. William Wright, a Jackson orthodontist and president of the Michigan Dental Association, which represents dental professionals. “Who is to say how much they are going to save once they get the bills from the emergency room? The emergency visits will increase soon.”

‘Going To See A Mess’

Dr. Barry Saltman, founder of Care Free Medical and Dental Clinic in Lansing, which serves uninsured people, said he didn’t expect the number of emergency room visits to rise dramatically for another 18 months. Saltman said it will take that long for lack of dental care to result in acute problems such as tooth abscesses.

“Then we’re going to see a mess,” he said.

Advocates have been asking state lawmakers to reinstate the Medicaid benefit this fiscal year. In October, a class-action lawsuit was filed in U.S. District Court in Grand Rapids seeking restoration.

Making Due

But there will be much pressure to continue the cut even into next fiscal year: Gov. Jennifer Granholm is asking her department heads to slash their budgets by 20 for the next fiscal year because of a projected $1.4 billion shortfall.

Even when the Medicaid dental benefit was in place, advocates say it was often difficult for low-income persons to get treatment. Many dentists will not accept Medicaid patients because of low reimbursement rates.

Meanwhile, low-income residents such as 61-year-old Barbara Kocsis said she will make due the best she can.

The Lansing woman, who needs at least one filling, said she is trying to maintain good dental hygiene by constantly chewing sugar-free gum to remove food from the cavity.

“I’ve been doing it all along. It cleans my teeth,” said Kocsis, chewing her gum. “There are so many people out there who need (help). I don’t know what else to do.”