On August 28, the New York Times published an article describing recent cuts in adult dental coverage through Medicaid. The article told the story of nationwide reductions in dental services offered by states through their Medicaid programs. The focus was on the latest state to cut adult dental benefits, Illinois, and another state that recently reinstated a small number of benefits, Massachusetts.
Prior to July of this year, Illinois was one of the few states still offering relatively comprehensive dental benefits to their adult (over 21 years old) patients through Medicaid. Until then, fillings, crowns, extractions, anterior root canals and full dentures were all previously covered in Illinois. In short order, the Illinois General Assembly voted to eliminate all comprehensive treatments and limit coverage to only emergency exams and extractions. Those changes took effect on July 1.
A few years ago, Massachusetts was also known for offering generous dental coverage. However the commonwealth ended Medicaid coverage of fillings, root canals, crowns and dentures in July 2010. Almost two years later, staring this January, Massachusetts decided to begin covering anterior fillings once again. Massachusetts hopes that restoration of the anterior dentition will help make patients receiving Medicaid better able to find and keep jobs.
As the NYT story points out, the impact of these cuts on the oral health of the poor population of states like Illinois and Massachusetts is impossible to ignore. These patients are more likely to wind up in a hospital emergency room where their dental problem cannot be solved by the antibiotics and pain medication the ER physician will provide. As a result, the patient will end up back in the hospital and end up costing the state significantly more than the approximately $80 it would have cost to extract a non-restorable problem tooth or the $50 (for regular prophylaxis) it would have cost to keep all the teeth healthy in the first place.
One factor the media coverage of these cuts neglects is the impact on dental schools and dental students. But don’t fret, that’s what this blog is for.
The University of Illinois at Chicago College of Dentistry receives about $1.5 million per year from Medicaid reimbursements. Children up to 21 years old will still be covered in Illinois, so that portion of the revenue stream will remain intact. However, there’s no question that the loss of adult coverage will reduce this source of revenue for the college. How will the college offset this deficit? The likely answer is further increases in tuition. However, the Illinois State Dental Society is petitioning the governor to either (1) grant the three dental schools in Illinois an exemption from the Medicaid cuts or (2) make up the difference in Medicaid revenue to the dental schools with additional state support. Given the fiscal crisis in Illinois, nobody is holding their breath.
There is also an immediate impact on students’ patient pools in Illinois. Those Medicaid patients that couldn’t otherwise afford care will not seek treatment and students will miss out on educational experiences and possibly procedures needed for graduation. Students must hope they can make up the difference in lost Medicaid patients with a solid core of cash-paying patients.
The Massachusetts situation for dental schools and dental students was no different. However, now Massachusetts dental students can again provide anterior direct restoration on their Medicaid patients. Regardless, dental students in Massachusetts, Illinois and all other states affected by dental Medicaid cuts should be motivated to take action on behalf of their patients, their schools and themselves.
So, what can dental students do? According to the Massachusetts Dental Society President, Dr. Paula Friedman, “Dental students are very effective public policy advocates. They are perceived as future voters and advocating for the purity of public policy benefits. Experienced dentists may be perceived – even if incorrectly – as self-serving in their professional efforts.”
You are all in a great position to catch the ear of an influential legislator. Now how do you accomplish that? Dr. Friedman explains, “The best way for dental students to become effective advocates is to partner with their state dental societies for mentoring, training and organizational support.”
Dr. Friedman offers some sage advice here: if your state is considering cutting dental Medicaid benefits, engage your state society and ask how you can help. Your advocacy in these situations can make a difference.
~ Ben Youel, Vice President, Illinois ‘13