Cutting off Medicaid dental benefits to adults with developmental disabilities is no small matter. In May of 2009, Governor Granholm did just that in an executive order in response to budget-wrecking declines in state revenues.
The cuts eliminating Medicaid-funded preventive dental care for adults over 21 years old, took effect on July 1st, 2009. They are described in changes to the state's Medicaid Provider Manual : "The adult dental benefit is limited to the following emergent/urgent services for the relief of pain and/or infection only... Routine examinations, prophylaxis, restorations, and dentures will not be covered. " In short, if you go to an emergency room with a toothache, Medicaid will pay for X-rays to diagnose the problem and for an extraction and maybe some painkiller, but will not pay to treat the underlying problem (such as periodontal disease), to fill a cavity, or to prevent the problem from occurring again.
For anyone who was already authorized for treatment of a dental problem before July 1st, 2009 and has a prior authorization on file, "providers have 180 days from the date the PA was approved to complete the services, according to existing Medicaid guidelines."
There are both short and long-term consequences to neglecting the dental health of people with severe disabilities: in the short-term, a tooth or gum infection that goes undiagnosed can result in pain, misery, infection, the loss of teeth, and even death. Ignoring gum and tooth disease may result in more expensive emergency room visits that fail to treat the cause of the problem. In the long-term, a lack of preventive dental care has also been implicated in the development of chronic diseases such as diabetes and heart disease.
As a parent, I mostly worry about someone like my Danny, who can't tell you that he is in pain or why he is uncomfortable. He can only show you in vague ways that something is the matter: he might have more seizures, be unable to sleep, scream (more than usual), or not want to eat. How do you rule out dental problems unless he has routine examinations, X-rays, and cleanings to diagnose problems early and either fix them or keep them under control? And what about people who have to be anesthetized for even routine dental evaluations? How bad will the problem have to be before Medicaid will authorize treatment or hospitalization or, in emergency situations, a dentist will have any confidence that a procedure will be covered by the person's Medicaid benefits?
There has been at least one death in Michigan since Medicaid adult dental benefits were substantially eliminated. According to The Grand Rapids Press in a story by Kyla King, Northern Michigan woman's death raises calls to restore adult Medicaid dental benefits, 10/22/09, a severely developmentally disabled woman from Alpena died reportedly from an untreated infection in her mouth. The woman had been scheduled for surgery in June 2009, but had other problems that postponed the surgery. Because of her severe disability, she needed to be hospitalized and anesthetized for the procedure. The dentists at the clinic in Cheyboygan, Michigan, were going to perform the procedure without charge, but the woman died while waiting for Medicaid approval of the $5,000 in hospital charges. The Michigan Department of Community Health admits that the death was indeed tragic and is looking into confirming the circumstances of the death.
The story in the Grand Rapids Press did not explain why there was a problem getting approval from Medicaid for the procedure when it was already scheduled for June, but was postponed. Was there not already authorization to do the surgery that would have covered the procedure for 180 days? Regardless of the details of the story, it is chilling that an infection in the mouth of a severely disabled woman could have resulted in death while awaiting Medicaid approval of coverage for a procedure that might have saved her life. How many more preventable deaths will it take before funding is restored for Medicaid preventive dental care?
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