Gov. Matt Bevin’s decision to end dental and vision coverage for 460,000 Kentuckians is vindictive, probably illegal and also illogical because emergency-room visits for dental problems will increase.
The administration’s excuse — that a federal judge’s rejection of Bevin’s Medicaid revamp necessitates the action — is ridiculous. The new payment mechanism for dental and vision coverage was to take effect July 1. The obvious answer is to keep the system that was in place June 30.
In recent days, Bevin administration officials have said they can’t say how much eliminating the dental and vision benefits would save or cost and that fewer than 10 percent of Medicaid recipients use those benefits.
From this we can deduce that Kentuckians are not abusing the benefits and must be using them when they really need them. Dental pain can be debilitating; trying to hold down a job when you have vision problems is difficult, if not impossible. One ostensible goal of Bevin’s Medicaid revamp is to encourage more Kentuckians to work or perform community service. Taking away their dental and vision care undermines that goal.
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Experience in other states tells us that ending Medicaid dental benefits forces people to seek care in emergency rooms, the most expensive place to treat them. Emergency rooms are not staffed or equipped to treat the causes of dental pain and, therefore, often just send patients home with a prescription for opioid painkillers.
About half the patients who went to the ER with non-traumatic dental pain from 2007 to 2010 received a prescription for opioid drugs, a much higher rate than for ER patients overall, according to a study published in 2015. We don’t need to explain why our fellow Kentuckians are better off with a root canal than an OxyContin script.
After California Medicaid ended comprehensive adult dental coverage in 2009 in response to budget constraints, dental-related visits to emergency rooms increased by more than 1,800 a year for a 68 percent increase in dental ER costs. Maryland had a 22 percent increase in dental ER visits after ending Medicaid reimbursement to dentists for treating emergencies.
Bevin has given contradictory explanations for implementing new premiums, co-pays and work or community engagement requirements for some Medicaid recipients. His administration has argued that Kentucky can’t afford to keep paying its share of the Medicaid expansion that was made possible by the Affordable Care Act so must shed an estimated 95,000 Medicaid recipients to save $330 million over five years. (What he doesn’t mention: Kentucky would give up $2.1 billion in federal funds.)
Bevin also has said he doesn’t know “nor do I really care” how much money his Medicaid changes would save.
As Nick Storm of Spectrum News reported, the Bevin administration cites paperwork that it quietly submitted on April 23, and which still has not received the necessary federal approval, to justify the cutoff. Bevin planned to convert dental and vision benefits to a “My Rewards Account” in which the 460,000 Kentuckians who received Medicaid through the ACA would earn those benefits through activities such as online classes.
But there’s no reason — other than spite against the 15 individuals who successfully challenged the plan and the groups that supported them — that the changes in dental and vision benefits cannot be put on hold just as the rest of the revamp has been put on hold by U.S. District Judge James E. Boasberg’s ruling last week. The judge found that federal officials failed to consider, as the law requires, the loss of health care coverage that Kentuckians would suffer as a result of Bevin’s Medicaid proposal.
Kentucky will challenge his ruling, meaning the dispute will be tied up in court for a while. Ending dental and vision care serves no public health purpose and would cause a lot of pain.