Decaying Care: Loss of dental benefits leads to larger problems

Loss of dental benefits leads to larger problems

November 1, 2009 

Karlyn Echols' smile is not a pretty sight these days.

She has a painful cavity under one tooth, her gums often bleed, and she needs three teeth extracted and replaced with a bridge.

Echols, 69, tried to get the dental work started in early June before the state cut off dental benefits for adult Medi-Cal patients in July. The X-rays were taken at Western Dental, a Medi-Cal provider, but because of a paperwork mix-up and the rush of patients, Medi-Cal never authorized her treatment.

Almost five months later, the homebound resident of Ralston Tower has nowhere to turn.

"I am in a lot of pain," Echols said. "I'm at the point I could have more infection and I could get an abscess in my mouth."

The dental benefits, along with podiatry, optometry, audiology and psychology services, are considered optional benefits in the federal Medicaid program, which partners with states to provide health care for the poor. (The program is called Medi-Cal in California.) Those benefits were nixed this year as Gov. Schwarzenegger and the Legislature dealt with staggering budget deficits.

Everyone from poor adults to disabled people and low-income seniors were left with no access to dentists, unless they could scrape up enough money to pay the bills.

The people who are hurting include:

— Sharon Jones, a disabled Oakdale woman who can't afford to have a dentist pull her broken and decayed teeth and fit her with dentures.

— Dovie Smith, a diabetic woman from Ceres, who needs treatment for extensive tooth decay and often requires foot care for sores and in-grown nails.

— Nora Winn of Waterford, who risks infection because she can't pay an oral surgeon to remove a decayed molar.

"The last time this happened, I got a bone infection," said Winn, a former social worker who was disabled by cancer. "I am really afraid it will happen again."

Untreated tooth decay may lead to oral infections that can spread and infect heart valves, leading to serious complications and the need for heart surgery, doctors said. Seniors with dental problems may suffer from weight loss and poor nutrition because they can't chew their food.

Medi-Cal still is covering dental care for children, patients in convalescent homes, pregnant women if it's medically necessary and developmentally disabled adults. It will cover emergency tooth extractions for

adults, so some people are waiting for excruciating toothaches to be deemed an emergency.

Once the tooth is taken out, Medi-Cal doesn't pay for a bridge to replace it, potentially exposing the patient to more tooth decay or gum disease.

"You can see how cruel that is to take dental care away from poor seniors and the disabled," said Michael Sullivan, executive director of Golden Valley Health Centers, a group of safety net clinics in Stanislaus and Merced counties. "These people don't have any options."

Echols said Western Dental told her a deep cleaning alone would cost $200 up front, plus monthly payments of $52.50 for nine months. That does not include the extractions and a partial denture, which easily could exceed $1,000.

She said she doesn't have the money because she barely gets by on Social Security.

Despite lobbying from the California Dental Association and health advocacy groups, there are serious doubts that state leaders will reinstate the benefits this year. With the state sinking into the red again, advocates worry that more cuts are coming in the budget year that starts July 1.

"We are down on the pecking list," said Bruce Valentine, a Modesto dentist and spokesman for the Stanislaus Dental Society. "It is purely a money issue. The governor took a program that the federal government said was optional and saw it as a way to save a lot of bucks."

Cuts in the courts

A federal judge in August denied a lawsuit by the Gray Panthers of San Francisco seeking to reverse the cuts, and the case moved to the U.S. Court of Appeals for the 9th Circuit, which could release a decision in one or two months.

If Congress approves a national health reform bill this year, advocates hope that dental care will become a mandatory Medicaid benefit.

Health care providers also worry about diabetic patients who relied on Medi-Cal for podiatric care, which can save a patient from losing a foot or leg.

Dovie Smith of Ceres said she regularly needs foot care for sores and in-grown nails caused by diabetic complications. Her podiatrist has said he will have to charge her $45 per visit, she said.

"I live on $845 a month," said Smith, who is disabled by multiple health issues. "After I pay for rent, utilities, phone and food, I may have $10 to $15 left."

Dr. Del Morris, medical director of Stanislaus County's health clinics, said he's been able to persuade private podiatrists to treat his diabetic patients for discounted fees, while other patients can go to general surgeons for covered procedures.

"A foot problem that isn't taken care of can result in losing a toe, which can lead to losing a foot and then amputation of the leg," Morris said. "This was Draconian. I know at the state level they are making a lot of hard decisions. This is one that is going to have bad consequences."

Before the benefits were cut, more than 65,000 Stanislaus County adults were eligible for Denti-Cal under the Medi-Cal program and, according to a 2007 study, almost 25 percent used the serv-ices each year.

Dentists, insurers try to help

Sullivan said some patients are taking advantage of Golden Valley's sliding payment scale for dental care, but "there is still a whole bunch of folks that are going without." Depending on their income, uninsured patients are expected to pay 25 percent to 75 percent of the costs of care at Golden Valley's dental clinics.

Some insurance brokers have tried to work with low-income seniors to purchase a stand-alone dental plan, costing $15 to $25 a month, but said many don't have money for the patient's share of bills.

St. Mary's Interfaith Community Services, at 545 W. Sonora St. in Stockton, has a free dental clinic for the homeless and the working poor. Dentists volunteer to do extractions, fillings and root canals. At 7 a.m. Mondays, the clinic hands out tickets for appointments that week; people usually start standing in line at 3 a.m., a receptionist said.

Some Medi-Cal patients who talked with The Bee last week were confused about certain cuts. To clarify, one of the cuts eliminated optometry, or eyeglasses, but Medi-Cal still covers retinal screenings and other eye care procedures required by diabetic patients.

Seniors and the disabled can use Medicare benefits to pay for cataract surgery.

Nora Winn of Waterford said it appears her only option is finding a part-time job, so she can pay an oral surgeon a few hundred dollars to remove the molar. "It is really frustrating," she said. "I used to pay a lot of taxes and I never thought this would be an issue."

Bee staff writer Ken Carlson can be reached at or 578-2321.

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