MASSHEALTH DENTAL CUTS
As part of recent budget cuts, the Swift Administration recently announced reductions in MassHealth adult dental benefits. In effect since March 15, 2002, the new regulations limit adult dental care coverage to emergency or serious services. Preventative care such as routine cleanings and fillings will no longer be covered in most cases. Dentures, limited root-canal to prevent the need of dentures and removal of impacted teeth now require prior-approval. Emergency services such as the treatment of pain, abscesses and extractions will still be covered.
Services for children were not changed; MassHealth will still cover exams, fillings, etc. for children under age 21. Members age 21 or over may qualify for "Special Circumstances" status under which they would receive the dental coverage available prior to March 15, 2002. "To demonstrate special circumstances the member must have either a severe, chronic disability that is… likely to continue indefinitely and results in the member's inability to maintain oral hygiene OR a clinical condition (such as human immunodeficiency virus or cancer) that has advanced to a stage where an infection resulting from oral disease would likely be life-threatening." [130 CMR 420.410(D)(1)]. The member's physician must complete a prior approval process with a signed letter that the person meets one of these criteria for a person to get this status and access these services.
In a recent Boston Globe article ("Swift To Cut Dental Care For Poor Adults" ) Rick Klein, Globe Staff, reports that
dental care is one of the few areas where the state can trim its $5 billion annual Medicaid program, since providing such coverage is not required by the federal government. Swift aides argue that this step avoids more draconian measures, taken in some other states, of changing Medicaid eligibility formulas to exclude more people who need health coverage.
The slashing of dental services could be the first of a series of cost-cutting measures Swift pursues in the area of public health. Medicaid officials are also considering a major change to the Mass Health prescription drug benefit, which some fear would deny patients key medications.
Beyond that, Swift is expected to eliminate a range of preventive services, such as cancer screening and antismoking programs, with the state facing a budget gap of as much as $2 billion next year….
Rob Restuccia, executive director of the health care advocacy group Health Care for All, called the policy "a terrible precedent." Denying preventive dental care such as cleaning and fillings guarantees the need for emergency care down the road, and those costs could wind up being greater, Restuccia said.
"It is just an outrage," Restuccia said. "You're saying that they shouldn't have dental services. How are they going to eat? Essentially, the department is saying to them, if you have a problem, we'll pull your teeth."
3/02