February 19, 2011

Modestan loses smile when Medi-Cal drops optional benefits

John Stygar doesn’t smile anymore.

With only four teeth remaining in his mouth, he’s too embarrassed.

“Everybody that knows me has mentioned that I’m not the same person, because I’m not the perky, happy, smiley guy that I used to be,” he said.

If he could, Stygar, 43, would like to get his remaining teeth extracted, then get dentures. Although the Modesto resident is too disabled to work, he thinks maybe someday — if his physical health improves — a nicer smile could help land him a job. At the very least, people wouldn’t stare.

But since the state eliminated Medi-Cal Optional benefits in 2009, John, his wife Tracy, and hundreds of thousands of disabled and very low-income adults covered through Medi-Cal no longer have access to dental care — or to a host of other services including podiatry and psychology.

The term “optional” refers to the fact that the federal government does not require states to provide such benefits to the poor and disabled. For the Stygars, such services don’t feel optional at all. They depended on the psychology benefit for help with depression, and podiatry for the plantar fasciitis that for both of them causes shooting pains in their feet. But losing dental was the worst.

When John first learned of the cuts, he felt betrayed. He’s struggled with learning disabilities and health problems since he was a child. Still, he worked hard and always paid into the system.

“It’s not a good feeling to know that the state and all that is not going to be there for you, when you’ve taken care of them by paying taxes and working your whole life,” he said.

John started working construction when he was 16. For the next two decades, he did hard manual labor jobs — building and moving and lifting. Because of his learning disability, he says, he was never cut out for an “easy job that takes a lot more brainpower.” But he took pride in his work. Then one day, about seven years ago, he suffered from a herniated disk while unloading a truck at Orchard Supply Hardware.

“My back popped and my legs went out and I pretty well knew that I was done,” he said.

He’d worked there for nearly a decade. They’d provided good health insurance. He tried to keep at it, but found he couldn’t stand up for very long. Even sitting hurt. When he lost the job, he lost his insurance. Because he was disabled, government coverage kicked in.

He took a course on property management and real estate, but his lack of experience made it hard to find a job, he said. Constant pain and bad teeth didn’t help.

If you’re making transactions involving hundreds of thousands of dollars, he explained, “You need to have your game face.” A game face, he adds, includes a smile.

He’d started having problems with his teeth a few years earlier, partly as a result of ongoing problems with his kidneys that prevent him from taking in much calcium.

Before the benefits were cut, he’d begun getting his teeth extracted. He planned to replace them with dentures. Now he’s afraid that if his remaining teeth are pulled out, he won’t be able to chew anything. He’s been told dentures will cost him thousands of dollars.

He, Tracy and their 14-year-old daughter live in Modesto on his monthly disability check of $882, plus $340 in food stamps. There’s just no room in their budget for dental care.

At various points, Tracy, 32, has held jobs in child care and at a thrift store. But she, too, struggles with a host of physical disabilities — including fibromyalgia, a disorder that leaves her in constant pain. Her teeth first started giving her trouble after she became pregnant. They’ve gotten worse over the years. At times, she says, related infections have spread to her blood and landed her in the hospital for weeks.

The pain in her mouth keeps her up at night. She says it radiates across her jaw, into her ears and through her skull. During the day, she carries around a thermos of ice to numb the abscesses.

Like John, she had some teeth pulled before the benefit cuts. As new teeth have become infected since, she’s turned to her primary care doctor for help. He prescribes antibiotics and pain medications. She’s no longer covered for extractions.

“I don’t want to have no teeth,” she said, her voice muffled through a mouthful of crushed ice. “But it’s like, I’m in constant pain. And when you’re in constant pain, you don’t feel good.”

“She’s in hell right now,” John added.

People often look at John and Tracy and make all kinds of hurtful remarks — or even wrongfully assume they use meth, he says.

“You have bad teeth,” said John, summarizing the attitude, “you must be a bad person."

He knows dentures wouldn’t solve all of his problems. Not the pain in his feet and back. Not the kidney disease. Not the learning disabilities. Not the financial issues. But he can’t help but think that life might get a little bit brighter, if he could only regain his smile.

Capital Public Radio will discuss The Bee’s series on “Insight,” its interview program, Wednesday from 10 to 11 a.m. Listen at KUOP 91.3 FM or www.capradio.org/news/insight .

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