Maryland’s new dental insurance program for low-income residents pays to remove teeth – but not replace them – Baltimore Sun


Bridget Morlan called the number of her very first dental insurance card and held her breath. After more than 30 years of dealing with broken teeth, gum infections and toothaches that landed her in the emergency room dozens of times, the Baltimore woman hoped the new blanket would make everything better.

“I wish for a miracle,” said Morlan, 53, whose teeth were badly damaged years ago by an abusive boyfriend and the resulting lack of care.

Maryland is one of 15 states that does not cover adult dental care with Medicaid, the government’s health insurance program for low-income people. But now the state has launched a pilot program to cover a small number of them – those with limited incomes who are also disabled. About 33,000 people are eligible for the adult dental pilot program, the first time in nearly 50 years that some adults on Medicaid in Maryland will have basic dental coverage.

Those eligible make up less than 3% of the roughly 1.4 million adults on Medicaid in Maryland — and the pilot actually doesn’t have enough money if everyone who qualifies seeks dental care.

The program offers preventive, diagnostic and restorative services. Concretely, according to dentists, a year’s care can include two oral exams, two cleanings and up to five fillings of cavities or dental extractions.

The coverage will pay to remove the teeth, but not to replace them.

“We would have liked a more comprehensive package,” said Mary Backley, executive director of the Maryland Dental Action Coalition, which led the program’s legislative support. “But we recognize that this is an important step.”

Dr. Louis DePaola, associate dean at the University of Maryland School of Dentistry, echoed Backley, calling the program a “first step” for people who don’t have dental care.

The program is driven by huge need — as well as a desire to cut costs, because the Medicaid program spends millions when these patients go to the emergency room for dental issues.

“Forget the pain: as a society, we’re going to save money,” said Dr. Tom Ritter, who is one of the local dentists who provided free care to the homeless at the annual Project Homeless event. Connect to Baltimore.

Asked by the General Assembly to study the cost, the DentaQuest Institute, a nonprofit research group, found that there were more than 42,000 visits to emergency rooms in Maryland for dental problems in 2016, for a cost of $22 million. Medicaid paid for more than half of those visits, at a cost of nearly $10 million.

A majority of these patients returned to the emergency room with a similar dental complaint within 15 days, according to the study. Those ER visits cost an average of $537 each, he said.

“The ER is overwhelmed with people coming in for a toothache,” DePaola said.

Lack of access to dental care for poor Americans is a long-standing problem, despite recognition of its effect on overall health. Almost 20 years ago, the Surgeon General of the United States declared oral disease a “silent epidemic” and linked poor oral health to other health problems such as diabetes, cardiovascular disease and adverse pregnancy outcomes. If left untreated, dental infections can even lead to death.

In Maryland, from 2013 to 2016, 15 people died in hospital after being admitted with serious oral health issues, according to the DentaQuest study. The state decided to offer dental care to children on Medicaid after the 2007 death of Deamonte Driver, a 12-year-old Prince George’s County boy who died when infection from an untreated abscessed tooth grew. spread to his brain.

“We shouldn’t see people dying from dental issues,” said Dr. Greg Allen, president of the Maryland State Dental Association.

In 2014, the DentaQuest study found that the rate of emergency room visits due to dental issues was 40% higher in Maryland than the national rate.

Locally, the city of Baltimore had one of the highest rates among state jurisdictions for ER visits for oral health issues, according to the study. At the University of Maryland Medical Center in Midtown, for example, at least 150 people visited the emergency room for oral health issues from July 2018 to June 2019, according to the hospital.

Dr. Amit Chandra, head of the downtown campus emergency department, said complaints ranged from an underlying cavity to a facial abscess. But he said most of these conditions would be preventable if patients had access to routine dental care.

Dana Sheppard, 62, lost her job and dental benefits many years ago when her multiple sclerosis became too debilitating. Since then, the anti-epileptic drug she takes has caused her once-beautiful teeth to decay. Regular dental visits would have helped control the side effects of his medication, the dentists said.

When she lost her front teeth, she stopped going to church because she was so embarrassed. Out of 32 teeth, Sheppard has only 10 left.

“I feel like a jack-o’-lantern,” she said. “The ones I have left won’t last unless I get help.”

Because she wasn’t able to chew properly, she said, she ended up under a feeding tube for some time.

Over the past six years, Sheppard said, she has visited the emergency room at Saint Agnes Hospital at least 10 times when the dental pain became unbearable. She hopes her new dental coverage will prevent such visits.

Emergency departments are equipped only to provide antibiotics or painkillers to calm toothaches.

“We’re just not trained to do a number of procedures, things like filling a cavity or generally extractions,” Chandra said.

Having a dental benefit under Maryland’s Medicaid program is not a new concept. Maryland offered full dental coverage to adults on Medicaid until 1976, when state lawmakers decided it was too expensive and cut all services except emergency care.

The Maryland Department of Health distributed $825,000 in grants last year to hospitals and organizations to provide dental care to low-income people. The budget for the Adult Dental Pilot Program in its first year is $4.2 million, half of which comes from the federal government. If every poor and disabled person eligible for coverage used the maximum benefit, it would cost more than five times the allocated money — about $26 million, according to state budget estimates.

“After the first year, based on the numbers, we will revisit funding if necessary,” said Dennis Schrader, chief operating officer of the health department.

State officials say they are using available money, as allocated in the state budget by the governor and legislature. They don’t anticipate that everyone who is eligible will eventually seek services under the program, said Deidre McCabe, spokeswoman for the state health department.

Medicaid beneficiaries can be hard to reach, state attorneys and officials say. Other urgent medical issues, lack of transportation and offices without wheelchair access may prevent these patients from making a first appointment, according to Backley of the dental action group. She said some people had received the welcome package for the pilot program but thought it was junk and threw it away.

Once state officials see how many eligible patients are using the program, they will assess whether it has an impact on overall health, Schrader said.

Advocates and state officials attempt to identify and overcome barriers to participation early on. The health department hosted webinars for dentists to learn more about the pilot program and how to become a provider. Advocacy groups have set up an advisory committee to provide the state with feedback from dentists in the field.

Meanwhile, critics say the program has one big shortcoming: Unlike most other states, it doesn’t cover root canals or dentures. These are crucial procedures for people whose teeth have been neglected for a long time. Replacing missing teeth can make the difference to a person being able to eat, smile and, if they are sick, get better, dental experts have said.

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For Morlan, learning that the program doesn’t cover dentures was heartbreaking.

“Why go halfway? What will it solve? she says.

Although she struggled over the years to find a stable place to live, Morlan found that fixing her teeth was a more pressing issue – due to the domino effect they had on all aspects of her life. his life. She developed a lisp. She can’t eat anything but soft food. She covers her mouth in embarrassment when speaking and thinks that many employers would turn her down because of her appearance.

Morlan said she took so much ibuprofen for her dental pain that she ended up developing an ulcer.

For now, she drives for Lyft to save money for dentures. With other sporadic medical issues, she doesn’t know when that will be.

As for Sheppard, she can’t wait to get the infected teeth out of her mouth. “It’s going to help me stay out of the ER,” she said.

But once those teeth are pulled, Sheppard will have at most seven.


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