23 June 2009

State Medicaid Cuts: This Will Hurt You More Than It Will Me

Story from the Detroit News

michigan medicaid insuranceAutomotive retirees aren't the only ones rushing to get dentist appointments this month.

Medicaid patients are swarming dental offices, too, hoping to get last-minute work done before the state-run medical program stops paying for cleanings, fillings, partials and dentures at month's end as a part of broader cutbacks announced in May to help balance the state's distressed budget.

The cuts affect adults age 21 and older covered by Medicaid, the federal-state program that provides health care coverage for certain low-income individuals and families.

Of Michigan's 1.6 million Medicaid enrollees, about 610,000 are adults. The budget cuts also eliminate other benefits, such as vision care, chiropractic services and podiatry, and reduce by 4 percent across-the-board Medicaid payments to physicians, hospitals and other providers, including dentists.

The cuts begin in the fourth-quarter of Michigan's fiscal year and will save about $53 million for the three-month period, state officials said. The cuts could extend into the 2010 fiscal year, which starts in October.

Dentists in urban areas such as Detroit, where there are a high percentage of Medicaid patients, fear the cutbacks will devastate business, delivering another blow to practices reeling from the recession. Dentists also worry more offices will reduce hours or close, further eroding options for low-income people living in the city and neighboring communities.

"It's a really distressing thing for all those concerned," said dentist Thomas Veryser, executive director of Michigan Community Dental Clinics, a nonprofit that specializes in treating Medicaid patients. Veryser said the cuts will further strain the organization's budget, prompting staff layoffs and halting construction of new offices.

Many health experts argue that any cuts to Medicaid will prompt costlier treatments in the future as patients rush to emergency rooms when their problems worsen.

The Michigan Medicaid insurance program will continue paying for emergency dental visits, such as tooth extractions, dentists say, but not for dentures or partials.

"They have access to emergency care but no access to care to replace those teeth," said Mert Aksu, dean of the School of Dentistry at University of Detroit Mercy.

Failing to replace absent teeth could lead to such as problems as shifting teeth and an inability to chew properly, Aksu said.

Michigan isn't alone in trimming Medicaid coverage in response to strained budgets.

Coverage for such services as dental, vision and podiatry are typically the first axed because they are considered optional, which means states aren't required to provide them to participate in Medicaid, which gets matching funds from the federal government, said Robin Rudowitz, policy analyst for the Kaiser Commission on Medicaid and the Uninsured, a part of the California-based Kaiser Family Foundation. It's up to each state to decide whether to offer optional services.

Michigan could also lose some federal matching funds by cutting optional services, Rudowitz added.

But compared to other states, Michigan has largely protected its Medicaid program from cuts, despite the state's high unemployment rate and dismal economic climate, Rudowitz said. And Michigan is likely to restore benefits once the economy rebounds, as has been the case in many other states, she added.

Still, for Mount Clemens Medicaid patient Caroline Lawrence, 37, the possibility of her dental benefits returning was of little comfort as she sat in the waiting room of a Detroit dental clinic, squirming from the pain throbbing in her cheek.

Lawrence set up an appointment with dentist Jerel Owens, one of the few oral surgeons she could find who takes Medicaid patients, to get her teeth pulled and would return for a denture.

But Lawrence fears she won't be able to get the denture before June 30 and may have to wait until dental coverage resumes.

"There is nothing I can do," she said, holding her hand to her cheek trying to soothe the pain. "I'll just have to suffer."

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