Forum explores possible loss of dental benefits for needy

As Gov. Christine Gregoire looks to slash state spending to offset Washington's drastically shrunken coffers, one target might prove tempting — dental services for poor adults.

Washington is one of only a few states that voluntarily provide dental coverage for adults on Medicaid, the federal-state insurance program for low-income families, the elderly and the disabled.

Dental coverage is guaranteed for children enrolled in Medicaid but not for those 21 and older.

When Gregoire presents her 2009-11budget next week, community advocates fear, optional dental benefits won't make the cut.

"Even when the budget deficit is small, it's always on the chopping block," said Tony Lee, advocacy director of Solid Ground, a Seattle social-services group.

Today, nearly a dozen dental and community groups are hosting a public forum in Seattle to preserve what they said is a small but critical safety net for the neediest adults. The event is at Town Hall from 10-11:30 a.m.

Washington spent about $36 million during the 2008 fiscal year on teeth cleaning, extractions and other dental treatment for 116,000 Medicaid adults. The state spent nearly three times as much, $98 million, for 330,000 kids. The federal government matched the spending dollar for dollar.

In 2003, then-Gov. Gary Locke proposed eliminating adult Medicaid dental benefits altogether. Locke was facing a biennial deficit of $2.6 billion — less than half what now confronts Gregoire.

The Legislature didn't go along with Locke, but it did cut the adult dental budget by 25 percent. Lawmakers did it by ordering Medicaid to drop coverage for crowns and some root canals, and by requiring prior approval for dentures. The cuts were restored in 2007 after the state grew more flush.

Lee said that eliminating adult dental coverage will stop care for people who already struggle to keep their teeth and gums in good condition. Lee also fears that the patchwork of community dental clinics and the few private dentists who still accept Medicaid patients will fray even further.

In Washington, adults other than those who are pregnant, elderly or disabled must earn 70 percent of the poverty level or less to qualify for Medicaid. For a single person, that's $7,280 a year.

David Hemion, assistant executive director of the Washington State Dental Association, said dental patients with severe infections but no insurance often end up in hospital emergency rooms. Treatment there might relieve the pain, but does nothing for the underlying dental problems, Hemion said.

Free oral surgery is particularly scarce. Medical Teams International is one of only a few places that provide it.

Hemion said the dental association is working to encourage more dentists to offer charity care. But Hemion said the need is too great to rely just on private largesse.

Hemion said lawmakers would be shortsighted to cut Medicaid dental coverage or reduce payments for children's dental services. Money spent now, he said, forestalls more costly problems later.

Warned Lee, of Solid Ground: "This is not a cost-effective cut."

Kyung Song: 206-464-2423 or ksong@seattletimes.com

Information in this article, originally published December 11, 2008, was corrected January 9, 2009. A previous version of this story incorrectly stated that Teams International and the University of Washington School of Dentistry are two of only a few places that provide it rather than Medical Teams International is one of only a few places that provides it.