Decaying Care: Loss of dental benefits leads to larger problems

Loss of dental benefits leads to larger problems

By Ken Carlson
kcarlson@modbee.com

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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.

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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."