State takes minimal steps to publicize temporary extension of Medicaid dental service

The Dunleavy administration, which announced it had ended Medicaid dental coverage as of July 1, has belatedly taken minimal steps to inform the public that the program has been extended to Sept. 30, an extension made necessary because the state failed to follow regulations requiring advance notice.

The state has not publicized the reason for the extension. And this document released Aug. 19 by the governor’s office concealed what was happening and did not make it clear to legislators, the press or the public that the July 1 cancellation had already been reversed.

Treatment has to start by Sept. 30 and finish by the end of October. Medicaid recipients are to get written notice that the program is ending, but by the time this happens, it may be too late to schedule an appointment.

My guess is that Gov. Mike Dunleavy and the state health department don’t want Medicaid recipients to use dental care in the next month and would love to see the program Dunleavy vetoed go away as quietly as possible.

It’s not clear how the state will pay for the temporary extension of the service, which was two-thirds funded by the federal government, because Gov. Mike Dunleavy vetoed $27 million for the program. The state will probably transfer money from somewhere else in the health department.

The Medicaid mistake is indicative of the chaos that is a hallmark of the Dunleavy administration.

As with most other aspects of Dunleavy’s budget, the state did no analysis on what ending dental care will mean to poor people or their health. After Sept. 30, Medicaid recipients will be able to get dental care only for the “immediate relief of pain or acute infection.”

The only justification given for the veto by Dunleavy’s staff is that when a Medicaid patient needs to have a tooth pulled in an emergency or suffers from extensive decay, the patient will be free to go to an emergency room at government expense.

These emergency services are likely to cost the state more in the long run, making the Dunleavy claim of savings an illusion.

But there was no analysis of this or of the benefits gained by using state money to leverage federal resources for better health care for people the state wants to get into the work force.

The Legislature voted twice this year to keep the service, which began in 2007 and limits benefits to $1,150 per year, but Dunleavy didn’t listen. He vetoed nearly $19 million in federal money and about $8 million in state money.

He certainly did not consider the findings in this 2015 national study by two researchers from the Centers for Disease Control that showed how the availability of dental care leads to more people visiting the dentist and better health.

Sandra Decker and Brandy Lipton wrote that their results “suggest that providing dental care may have effects that reduce spending in the long term. In particular, our findings imply that individuals who gain dental coverage are likely to enjoy better oral health. With fewer oral health problems, non-routine visits to the dentist could decrease over time. Past work also shows that dental coverage may lead to substitution of routine care for emergency care, which could lead to a reduction in overall spending on dental care.”

And Dunleavy didn’t consider the research from the Center for Health Care Strategies, about what happens when dental problems are ignored: “Poor oral health can elevate risks for chronic conditions such as diabetes and heart disease, as well as for lost workdays and reduced employability. It can also lead to the preventable use of costly acute care. A recent study identified $2.7 billion in dental-related hospital emergency department visits in the U.S. over a three-year period. Thirty percent of these visits were by Medicaid-enrolled adults, and over 40 percent were by uninsured individuals.”

A lot of this information will be looked at, no doubt, by the new Dunleavy Dental Director, who will get $300- an-hour working 20 hours a month under contract, to “develop oral health program priorities in a written Oral Health Action Plan with assistance from tribal programs to identify gaps in oral health services to Alaska’s most vulnerable populations.”

To help the Dunleavy Dental Director, the Legislature should override the Dunleavy dental veto, keeping this cost-effective program—mostly funded by the federal government—that helps some of Alaska’s most vulnerable people keep their teeth.

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