KDA Today

KDA Today

For Immediate Release

Date: Sep 12th, 2016
Contact: Dr. Bill Collins
Phone: 800-292-1855
Email: info@kyda.org

Does Frankfort Need a Better Understanding of our Medicaid Population?

Greetings from the Mountains of Eastern Kentucky. I hope everyone’s spring and summer are developing into wonderful family times. I feel as if we have started a marathon that has no end. Between trips to DC, to Atlanta, to Frankfort and other meetings, I am beginning to wonder when I am going to find time to practice.

The trip to Atlanta was filled with a collage of individuals from all aspects of oral health in the Southeastern United States. I met individuals from southern dental associations, hygiene associations, social workers, state Medicaid directors, state oral health directors, university representatives and the list goes on. The DentaQuest foundation funded the meeting and are helping fund State Oral Health Coalitions. Oral Health 2020 is sponsored by DentaQuest and is growing at an unprecedented pace in membership. I was impressed with their knowledge of oral health and their commitment of involvement. These individuals know their legislators and know the method of contact; they are most definitely in-tune to the discrepancies in oral health and they have the intent to make things better. We must become allies to the oral health coalitions and provide the answers and guidance they request from us. They are definitely team players and want to become part of the oral health team.
What’s big on the horizon? Medicaid, as usual. The waiver has taken front seat and is the “talk of the town” with the Public Hearings. Governor Bevin and the CMS have developed Waiver 1115 to eliminate dental and vision from Medicaid expansion. It will involve every able-bodied individual that receives Medicaid. The individuals must earn “My Rewards” points in order to obtain credits for Dental, or Vision, or a Gym visit. When Governor Bevin first came to office, if my memory serves me correctly, Dr. Narramore, Dr. Price and Executive Director, Rick Whitehouse were told, “You will have a seat at the table for Medicaid.” I am now wondering where that table was located, because surely we missed the opportunity to be involved in the discussion of this waiver. I am still in hopes this has been an oversight and they are not comparing dental and vision to gym visits.

Why does this concern me so much? There are few employment opportunities in Eastern and Western Kentucky outside the major cities. Our economy was based on coal and that train seems to have left the station. If the good Governor wants to start getting people off Medicaid, he should be bringing jobs to Eastern and Western Kentucky so the people can function without Medicaid. Ever hear of getting the cart before the horse? I think that is exactly what is happening. Also, when you remove dental visits, you increase emergency room visits. According to an ADA article, “The number of emergency department (ED) visits for dental conditions in the United States continues to rise. In 2012, ED dental visits cost the U.S. health care system $1.6 billion, with an average cost of $749 per visit.” A dental visit for a Medicaid patient can be as low as $41.00 to do an extraction and a radiograph at a dental office that accepts Medicaid. I am sure those in Frankfort have not considered the rise in ER visits.

A long-term study from United Concordia Dental shows that regular dental treatment and maintenance has a major impact on patients with diabetes, cerebral vascular disease (stroke) and coronary heart disease. Over a five-year period, hospital admissions decreased significantly for patients with chronic illness who received regular preventive dental care. Admissions were down 39.4 percent for diabetes patients, 28.6 percent for patients with heart disease, and 21.6 percent for stroke patients. Annual medical costs also decreased dramatically; costs were more than 40 percent lower for diabetes and stroke patients, and a staggering 73.7 percent lower for pregnant women.

Secretary Glisson stated at one of the Public Hearings, “We (meaning the individuals) do not understand the wavier, fully.” I have to agree with her that I personally don’t understand why anyone would want to eliminate vision and dental coverage for our underserved and uninsured population. I personally feel they don’t understand the health status of the Medicaid population. When they make statements like the state has poured more money in since 2014 than ever before, it makes me think they are not realizing that was when the Medicaid expansion began and so naturally they would have poured more money in - if not, the ACA would not have been working as it had been designed.

Oral Heath America recently stated, “The Medicaid dental benefit is currently one of the few options available for lower income older adults seeking oral healthcare. Medicaid dental benefits vary by state, and in eight states (AL, AZ, DE, KS, MD, SD, TN, TX) coverage is non-existent. Only four states provide comprehensive coverage (CO, IA, NE and WI). This dilemma is exacerbated by the fact that Medicaid dental benefits are in continuous flux and often subject to elimination when state budgets are constrained. Oral Health America recommends that consumers in states that have not expanded Medicaid programs to include oral health, work with advocates to reinstate or establish Medicaid dental coverage. The Affordable Care Act does not define adult dental as an essential benefit, which puts lower income older adults at a particular disadvantage. According to OHA’s 2015 Public Opinion Poll of 1,018 older adults, 59% of lower income older Americans lack dental insurance because of inadequate financial resources and the need to cover the costs of daily living, like housing, food and transportation. Forty-eight percent also have not seen a dentist in five years or more, because of cost.”

Well, I have beat Medicaid to death, again, and for that I apologize. But many of our members are Medicaid providers and they should know that 400,000-plus individuals are at risk of losing their dental and vision benefits. Please make your voices heard and let the legislators know that dental benefits are not comparable to “gym visits”. As more states are seeking to reinstate Medicaid benefits, Kentucky is seeking to omit them!

As always, I have to mention the importance of the KDPAC and the importance of gaining the “ear” of your legislators. As we progress on through the election year, many legislators may be contacting you to hold a fund raiser or provide support. Don’t hesitate to say yes - the future you are saving is yours. Dr. Narramore and Dr. Johnson are always willing to advise and help with the “how to’s” of these types of events. We also have Libby Milligan and McCarthy Solutions ready and available with answers.

As the sun begins to set over the majestic mountains of Eastern Kentucky, I still sit wondering what happed to that table to which we were to be included. Mother Teresa once said, “Our life of poverty is as necessary as the work, itself. Only in heaven will we see how much we owe to the poor for helping us to love God better because of them.” Maybe our people in Frankfort will try to better understand the Medicaid population before they proceed with ideas that underestimate the severity of the real problems.

As I get older, I look forward to the days of sitting in the rocking chair on the front porch. But, then I realize, I will never be able to slow down. Look at our past interim Executive Director, who is now performing life guard duties in Kentucky. Can you believe this man can swim 300 yards dragging a lifeless body? Or better yet, can you imagine him with his little red swim suit like on the old series Bay Watch? As time progresses, I often think of what Pierre Teilhard de Chardin once said, “Growing old is like being increasingly penalized for a crime you haven't committed.” Enjoy the rest of the summer - fall will be upon us before we blink.

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