Lawmakers may finally restore funding for dental coverage for adult Medicaid beneficiaries.
As the state faced severe budget cuts brought on by the Great Recession in 2009, dental coverage for adults on Medicaid was cut. Only emergencies have been covered since.
That meant emergency visits to have teeth pulled when no other options were left, and no six-month checkups or cleanings. Although a decade has passed, preventive benefits have not been restored.
“Those of us in oral health have always been baffled by government's ability to cut out a piece of the body and say that this is not important. That is just not true,” Dr. Anthony Kim said. He is the chair of the Hawaiʻi Oral Health Coalition and a dental director at Waimanalo Health Center.
“We believe, like all health professionals, in caring for the whole person, and to basically cut out coverage for a part of the body doesn't make any sense.”
There are poor outcomes when oral health is ignored.
“It can exacerbate diabetes and heart disease leads to problems with depression and low self-esteem. When faced with no choices, when you go to the dentist, besides pulling a tooth out, many people will simply not go and their conditions get so bad that they either end up having to go to an emergency room, or finally have to make the devastating choice of losing one or more teeth.”
A 2021 study by HOHC found that 29,536 adults over the age of 21 visited the ER with a dental-related diagnosis between 2016 and 2020. That amounted to $12.3 million in charges to Medicaid.
“We're now looking at emergency rooms seeing upwards of 3,000 oral health problems a year across a state, and more than 50% of those emergency room type visits are occurring on the neighbor islands,” Kim said, adding that Native Hawaiian and Pacific Islander populations are disproportionately affected.
Executive budget versus appropriation
House Bill 1754 aims to restore the benefits. The dental benefits could affect 223,438 adult Hawaiʻi residents.
The bill received overwhelming support from medical associations and health insurers such as AlohaCare, HMSA, Kaiser Permanente, and United Healthcare.
In written testimony, the state Department of Budget and Finance commented that the Department of Human Services already included $3.47 million in state general funds and $6.7 million in matching federal funds in its FY2023 executive supplemental budget to cover these costs.
In its testimony, DHS supported the intention of the bill, but requested that the appropriation be made in the executive supplemental budget.
"Including an appropriation via this measure would only be a one-time appropriation, which would not support the necessary continuity of an adult dental program," DHS said in written testimony.
Benefit plan options
The budgeted money would only cover a limited dental plan.
DHS’s Med-QUEST Division with the Health Policy Institute of the American Dental Association released a study on cost estimates in 2020.
The proposed budget would focus only on prevention and oral disease control and cover procedures like X-rays, cleanings and fillings.
A second option – which would cost $8.8 million in state money and $17.1 million in federal money – would also add some root canals, crowns and dentures.
A third option – at a cost of $16.1 million in state money and $31.3 million in federal money – would cover most dental procedures.
At a hearing of the House Health, Human Services & Homelessness Committee on the bill on Feb. 10, Patrick Donnelly, Statewide Oral Health Coalition Manager of the Hawaii Public Health Institute, said in oral testimony that the state would likely see many adults with significant dental problems because of the absence of routine coverage for more than a decade.
“I think the basic package is a step in the right direction, but will be less than adequate in addressing those high needs, and we want to consider avoiding driving patients back into the emergency rooms,” he said.
At the House Finance Committee hearing Thursday, Rep. Bert Kobayashi asked if there were more than the three options. Judy Mohr Peterson, the state’s Med-QUEST Division Administrator, said further options are possible would need to be explored.
The bill passed unanimously out of the House Finance Committee — but no dollar amount was given. It will now go to the House floor before going to the Senate.
Kim of HOHC said he hopes that the funding appropriation will be more robust than what DHS requested.
"I believe that even with the Federal matching dollars, the amount that was requested by DHS is inadequate to ensure impactful dental coverage," he told HPR via email after Thursday's hearing. "It is highly possible that when DHS made the request, they had no idea that the State was sitting on a billion dollars from the Federal government.
"12+ years of dental neglect for over 120,000 to now 220,000 adults cannot be wiped out in 3 visits to a dentist."
