Pennsylvania’s adult Medicaid recipients are facing reduced options for dental care.
Due to state budget cuts, Pennsylvania’s approximately two million Medicaid recipients have been reduced to basic dental care — eliminating root canals, dental crowns, periodontal disease work and limiting the number of dentures a patient can receive. The plan covers checkups, basic cleanings, fillings and extractions.
“Our Medicaid budget is outpaced by only two other states and we have to look at how to keep a (limit) on our spending,” says Department of Public Welfare spokesperson Donna Morgan.
Morgan says dental care is actually an optional service under Medicaid and coverage varies from state to state.
DPW estimates that the change will save $42 million this year.
Temple University Kornberg School of Dentistry Dean Amid Ismail says the cuts in benefits could impact the overall dental health of Medicaid patients.
“Not to provide comprehensive care really limits the outcomes of care — which should be focused on health, rather than just treatment of disease and extraction of teeth,” says Ismail.
“With the selected cuts to the most advanced type of services, we ended up with a situation where we will examine adults, we will fill their teeth and we will extract them, but we cannot replace teeth.”
“There may be a need to rethink how to reduce the program and save money without cutting the capacity to provide care so that people will choose the best outcomes,” Ismail added.
Approximately 40 percent of Temple’s dental patients are adult Medicaid recipients. Ismail says Temple has seen a slight drop in the use of root canal therapy and an increase in tooth extractions due to the cuts.
“Basically the only option they are leaving patients is to extract the teeth once they get to the point to where they need a root canal, or pay out of pocket, which for many people is not an option,” says Dr. Andres Pinto, chief division of Community Oral Health, Penn Dental Medicine.
Pinto noted that the change in Medicaid dental coverage is having a far-reaching impact.
“The impact is pretty big. It’s impacting patients. It’s impacting the way we educate students.”
Pinto says that some insurance companies are also following suit and offering a similar type of reduced dental coverage to their customers.
There may be some recourse for patients who need to have periodontal work done.
Morgan says Medicaid patients who need to have periodontal work can apply to have the procedure covered under a benefit limit exception.
According to Morgan, 7,699 requests for appeals were filed from October 2011 through May 2012. However, only 853 have been approved to date.
Temple University’s Maurice H. Kornberg School of Dentistry has marked 150 years of providing dental care.
As the nation’s second oldest dental school, the institution has served a key role in tracking the history of dentistry and dental disease in the United States.
“When the school was established in 1863 during the Civil War, it was a school established for a purpose and that purpose was to educate dentists using a structured curriculum with defined outcomes,” said Dean Amid I. Ismail.
“The milestone for us is that we are recognizing this historical moment in terms of the context of the different phases of the dental school, with the changes in disease patterns, as well as changes in technology.”
When the school was established, dental disease was primarily treated through the extraction of teeth. Ismail said that later part of the 19th century ushered in the next movement in the era of dental care, restorative dentistry.
Today the school is focused on bringing more services to the community.
“We want to be more focused on the community we serve. Rather than they come to us, we want to go out into the community,” said Ismail.
To that end, the school has undertaken initiatives such as working with the Woodstock Family Center to launch a dental care program for homeless children and negotiating with a federally qualified health center to operate a dental clinic in West Philadelphia.
In February, the dental school partnered with UnitedHealthcare to launch Project ENGAGE, a $1.75 million initiative design to improve children’s access to oral health care. The program is available to North Philadelphia children under the age of six and their families who are enrolled in the state’s Medicaid plan. The goal is to eventually expand the initiative to other parts of Philadelphia, Pennsylvania and throughout the country.
Over the past five years, the school has invested more than $27 million toward expansion and renovations, increasing its ability to service the community and provide the best learning experience for student dentists. According to Ismail, the school has been providing affordable care to about 35,000 patients per year.
“Our motto is to be both a patient care center and educational center – it’s like two sides of the same coin,” said Ismail.
Ismail said the dental school has adopted a preventative care model.
“We focus on health, not just treating disease. We are moving from extraction, when we first started, to restorative (care) to prevention to health promotion,” he stated.
The dental school marked its significant milestone with a weekend of activities April 12-13. Activities included a gala celebration at the Barnes Foundation, tours of the dental school and a free service clinic for patients.
The institution was founded by John H. McQuillen in 1863 as the Philadelphia Dental College. The college became affiliated with Temple in 1907.
Kornberg School of Dentistry’s Historical Dental Museum Collection features an online database of 4,000 photos and artifacts that have been used throughout the history of dentistry.