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Budget Cuts Are a Pain, Literally,
for Poor and Elderly with Dental Problems

By Michael P. Norton, State House News Service

STATE HOUSE, BOSTON, SEPT. 17, 2003….Brad Dumas recently had all of his top front teeth pulled and the taxpayers paid for it. Now he needs dentures. He can’t afford them and this time, the taxpayers aren’t paying.

“I don’t have the money to buy the dentures,” Dumas told lawmakers today. “And as I sit here today with a ton of stitches in my mouth, I really need to get the dentures.” An untreated infection forced the extractions, Dumas said.

Dumas is one of hundreds of thousands of poor adults and elderly citizens who are no longer eligible for state-funded dentures, eyeglasses, and dental work coverage. The benefits formerly covered by Medicaid, the government program that serves nearly 1 million people in Massachusetts, were slashed to balance the state budget.

State officials have not rejoiced in making the cuts, but say opposition to new taxes and anemic growth in tax collections due to the prolonged economic downturn have forced them to pare almost every item in the state budget.

And just as few of those pushing restoration of benefits offered viable funding sources, legislators at today’s Health Care Committee hearing made no ironclad pledges about restoring benefits to the roster of safety net programs.

Instead, the talk at the hearing centered on how the cuts are affecting hospitals and people.

“Women have lost their jobs and then lost their teeth and no one will hire them,” said Rep. Kathleen Teahan (D-Whitman), sponsor of a bill that will restore $30 million worth of vision, dental and other Medicaid benefits.

Teahan said it will be an “enormous challenge” to restore the benefits, due to still-severe state fiscal problems and what she feels is inadequate media focus on the issues facing the poor. “There were no TV cameras there today,” she said in an interview following the nearly four-hour public hearing. “The public doesn’t know these things.”

Teahan said she finds herself fighting the perception, fueled by talk radio, that those on public assistance programs are “lazy” or “milking the system.” She has reached the opposite conclusion after serving for nearly seven years in the Massachusetts House. The working poor, she said, want to work their way up, but need help overcoming illnesses, disabilities and poverty.

No one testified against restoring benefits, though a top Romney administration official submitted written testimony opposing Teahan’s bill. Acting Division of Medical Assistance Commissioner Douglas Brown said the administration on July 1 restored some orthotic and prosthetic services under Medicaid, but is fiscally constrained.

Speaking to the idea of restoring dental and vision services under Medicaid, Brown wrote: “As a result of the state’s fiscal crisis, it was unfortunate but necessary for the division to discontinue these important services. The division has had to rein in spending while preserving core service areas, and has very limited tools for doing so.” Brown added that dental and vision services are optional under federal Medicaid rules.

Hospital executives said inadequate Medicaid payments are stressing all hospital departments while advocates for the vulnerable said the poor, elderly and the most needy are suffering, often silently and out of the public eye.

“Our society has just turned their back on them,” said Eric Chen, a Holyoke-based dentist. As one of the dwindling number dentists still serving Medicaid patients, Chen said, he is seeing patients travel dozens of miles to his office.

Chen said Medicaid, when it covered dentures, would reimburse him $625 for the work Dumas needs. That’s $25 more than Dumas’ monthly income, which comes in the form of a $600 government disability check.

According to Chen, Medicaid now covers only the final chapter of dental care – extractions. He said that means poor people who can’t afford cleanings, bridge work, fillings or route canals are waiting for their teeth to rot. And poor hygiene, he said, is not going to help the downtrodden work their way off public assistance programs.

“They do come out of welfare and find a job, but they need this safety net,” Chen said.

Sen. Susan Fargo (D-Lexington) echoed claims by advocates for the needy that cuts in basic care will lead to more serious and costly health problems and force more people into the so-called free care pool, which uses surcharges paid primarily by hospitals and insurers to cover the cost of treating the growing numbers of uninsured.

Dental screening coverage, Fargo said, is especially important. “Cutting out dental benefits does remove a very important screening to perhaps help prevent more costly illnesses down the road,” said Fargo.

Boston City Council member Michael Ross said he has recently learned that residents in need of dental care at elder homes are skipping meals because it hurts to eat. Ross has joined dental plans and dentistry schools to piece together an informal program to meet treatment needs on a case-by-case basis, but says a better approach is needed.

“It’s really sad what’s happening in government today,” Ross said.

Hospital executives say Medicaid, which serves nearly 1 million people in Massachusetts, covers only 71 percent of the cost of care delivered to those enrolled in the joint federal-state program. And hospitals recently learned that Medicaid reimbursement rates for hospital fiscal year 2004 will effectively reduce overall payments by $46 million.

The Medicaid payment rates are contributing to escalating losses. And cuts in government health care programs and employer-sponsored insurance are pushing more people into the free care pool, hospital officials say. One quarter of the state’s hospitals have closed in the last decade, according to the Massachusetts Hospital Association. The hospitals remaining are operating at nearly full capacity, the association says. Patient demand is steadily increasing and association officials believe it could soon outpace the availability of hospital beds.

“The state needs to rearrange where it puts its money,” said Teahan. “To put it on the preventative and maintenance end is a lot wiser than paying two to three times more on the other end. It’s all a vicious circle. The hospitals end up giving more expensive free care and they end up going more into the red. They have emergency room diversions and closings and that affects all of us.”


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