Fluoride Action Network

Taking Medicaid From the Poor to Fund Fluoridation

Fluoride Action Network | Bulletin | May 31, 2016

By Ellen Connett (Managing Director) & Carol Kopf (Media Director)

A very concerning development has occurred in New York State which we suspect may become a toxic blueprint for other states: New York has approved the use of scarce Medicaid dollars for fluoridation programs in a dangerously misguided attempt to provide low-income communities with “dental care.”

According to James Helgerson, director of New York’s Medicaid program, “New York seeks to become the nation’s health care reform laboratory.”  One of these “reforms” includes “Medicaid Support of Water Fluoridation.”

Medicaid is the primary source of health insurance coverage for low-income populations. In New York’s budget for 2015, Medicaid dollars will pay for the

“planning, design and construction, and start-up of fluoridation systems, and replacing, repairing or upgrading of fluoridation equipment for such public water systems…”

It’s a new low to take scarce medical insurance dollars from the poorest and most disadvantaged people in New York and earmark it for forced fluoridation programs, particularly when there is evidence showing that low-income communities are at higher risk of suffering harm from fluoride ingestion. In fact, a study conducted in New York found that fluoridation is associated with a significant increase in pre-term births, and specifically found that “this relationship was most pronounced among women in the lowest SES groups and those of non-white racial origin.”

Pre-term birth is a serious issue, as it increases the child’s risk for a range of health problems, including learning and behavioral disorders.

Yet, incredibly, although the New York pre-term birth study has never been refuted, policy makers have begun aggressively pushing fluoridation on the very population identified in the study as being at greatest risk of harm.  We’ve often said that fluoridation is being “driven on the backs of the poor,” but the use of Medicaid dollars to force fluoridation on low-income communities, is the most offensive promotion tactic we have yet seen.

And it’s not just New York, as there are lobbying efforts afoot in other states (e.g., Michigan) to use Medicaid dollars to push fluoridation in a similar manner. Most worryingly, in 2009, William Bailey, then Director of CDC’s Division of Oral Health, suggested that future lobbying efforts be made to condition the federal government’s funding of each state’s Medicaid program on a state’s success in implementing fluoridation. If successful, states that do not fluoridate a required percentage of their communities would be penalized by suffering reductions in the federal funding for their Medicaid programs.

The Medicaid Grab in New York

In an effort called “Redesigning New York’s Medicaid Program,” New York’s Governor established the Medicaid Redesign Team (MRT) in January 2011. The MRT reviewed various ways by which health disparities in different population groups (i.e. race/ethnicity, gender, disability status, etc) could be reduced. Out of 69 recommendations, the MRT group finalized 14 projects. Number 13 was:

Medicaid Coverage of Water Fluoridation: To address disparities in access to dental services the Workgroup recommends that Medicaid funding be made available to support costs of fluoridation equipment, supplies and staff time for public water systems in population centers (population over 50,000) where the majority of Medicaid eligible children reside.

Along with paying for fluoridation equipment, this group made other recommendations that became part of the NYS Fluoridation Law in 2015. These recommendations were bundled in the Governor’s 2015-16 budget, which was passed by the legislature and signed by the Governor. These other recommendations, which are now law, throws obstacles in the path of local officials’ power to stop fluoridation, even when constituents demand it. The new law puts power into the hands of unelected pro-fluoridation bureaucrats on the state level. Dubbed, “The Healthy Teeth Amendment,” it requires that 90 days public notice be given to the State Department of Health when fluoridation will be stopped (but not started), a list of alternatives to fluoridation, and consultation with health professionals and the Department of Health.

How did they get away with it?

The campaign in New York to use Medicaid dollars for fluoridation was cloaked in secrecy, and advanced through a stealth decision-making process that left little time for public notification or input, particularly for residents concerned with fluoridation. (We both live in NYS and follow the issue very carefully, and yet we knew nothing about this.) The Medicaid Redesign Team (MRT) has received similar criticisms from other groups impacted by their decision making. Here, for example, is an an Action Alert that the group Save our Safety Net Campaign sent out in 2011:

We are saddened and angered by the “rush to judgment” on February 24th in the vote of the Medicaid Redesign Team to approve a package of recommendations that you had in your hands for less than 24 hours.  There had been major changes in what recommendations you were being asked to vote on, yet you voted.  The information was just made available on the web site the same day as the vote.  The aborting of the time frame by five days meant the public had no opportunity to review, digest, and comment on this package – much of which will have a dramatic impact on people’s lives.

The process had so many flaws that it would be difficult to name all of them.  But while trying to appear as this was a public transparent process, in the end it was anything but open and public…

Action Alert Email to the MRT (Medicaid Redesign Team) from the Save our Safety Net Campaign. March 2, 2011.

Upon learning of the MRT’s recommendations for using Medicaid dollars for fluoridation, a group of concerned citizens—including FAN Senior Advisor Paul Connett, PhD—converged at the MRT’s May 4, 2016 public meeting in New York City. (You can watch Dr. Connett’s 5-minute speech to the MRT here.)

But MRT’s recommendation had already been implemented by the Governor’s office prior to the meeting, so Medicaid funds are now currently being diverted into new and old fluoridation projects through a series of grants being made available to New York communities.

FAN recently wrote a letter to the Director of NYS Medicaid, James Helgerson, in which we called for a “moratorium on the use of NYS Medicaid funding for fluoridation projects” and asked Helgerson “to consider instead the use of these funds for alternative programs that have proven to be successful in improving the dental health of low -income children without any risks to the child.”  In the letter, we identified fluoridation as an Environmental Justice issue, due to the heightened burden it imposes on communities of color.

The NY Communities that are Being Targeted

If you live in a non-fluoridated area in New York, your community may currently be–or may soon be–targeted with a stealth fluoridation effort.

In 2015, Dr. Jay Kumar, former Director of Dental Health in NY (and now Director of Dental Health in California) identified the following NY communities as being targeted with fluoridation:

  • Albany County: City of Albany
  • Broome County: Johnson City Water Works
  • Cortland County: Cortland
  • Dutchess County: Poughkeepsie
  • Nassau County: All of county
  • Rockland County: All of county
  • Suffolk County: All of county
  • Tompkins County: Ithaca
  • Tompkins County: Cornell University
  • Warren County: Queensbury Water District

As part of this targeting effort, the state is offering free grants to communities to help fund the start-up costs for fluoridation. Up to $50,000 in Medicaid dollars will be given to communities for engineering studies to evaluate the cost to put in a fluoridation system. Another grant, up to $1 million in Medicaid dollars, would be to pay for the installation of the fluoridation system.

The second round of grants are being heavily publicized for communities to take advantage of as there is a deadline date of August 31, 2016. Information about these grants can be found here and here.

In February 2016, one of us (EC) observed first hand the lobbying effort that is now afoot to get non-fluoridated communities to accept this grant money.  At a February Cortland City Council meeting, a presentation was made urging the Council to apply for one of these grants. County health officials told the councilors that all they had to do was have the Mayor sign the application, and the County Health Department health would fill out all the forms. The County’s Environmental Health Director Michael Ryan even told the Council, “Every economically thriving community is fluoridated.”

There were several residents who attended the meeting because they heard fluoridation would be discussed. To a person each of them urged their council to say no to fluoridation. And they did. But the county’s health officials didn’t stop there. In March, a resolution was put before the Health and Human Services Committee of the Cortland County Legislature “to Support Fluoridation of All Community Water Systems Within the County.” Thankfully for the residents of Cortland County, the committee members said no!

What we need do in New York:

  • Call your local health commissioner and legislators to find out if they have already been approached and lobbied to take fluoridation funds.
  • Consider starting a watchdog group in your community to follow this.
  • If you live in NYS and want to be part of a statewide Working Group to strategize on efforts to undo this shameless initiative, email Carol Kopf.
  • Start now to attend city council meetings and county health department meetings if your community is not fluoridated.  Express your opposition to fluoridation – whether or not they have any plans to do so now.
  • Please email Ellen Connett if you know that your community has accepted, or is considering, these grants.

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