Medicaid cutbacks painful for patients and dentists alike

Concepcion Cabrera needs a restoration, scaling, and planing, but after paying for food, rent, and taxes, there's nothing left of the $925 she gets every month from Social Security.

"I don't know what I'm going to do," she said after an examination last week at La Clínica de La Raza in Oakland, CA.

A few weeks ago, California's Medicaid dental program, Denti-Cal, would have paid for all or most of the work Cabrera needs. But starting July 1, those benefits no longer exist. California lawmakers terminated them as part of efforts to reduce the state's huge budget deficit.

The cut is hurting many like Cabrera who have no where else to turn for dental care. And it's affecting dental professionals, too. Dientes Community Dental Clinic in Santa Cruz has laid off its dental director, Hugo Ferlito, D.D.S. Without income from adult Denti-Cal, said Development Coordinator Milena Friend, "there just wasn't the budget to continue that position." The clinic also laid off a part-time administrative assistant, she said. Other clinics across the state say they anticipate similar layoffs soon.

Advocates for the poor fought the cutbacks with rallies and demonstrations. A coalition of clinics tried suing the state but lost. In a separate lawsuit, healthcare providers, including dentists, were able to stave off a 10% cut in their Medicaid reimbursement.

But the prospects for Denti-Cal being restored look dim. Although the Legislature and Gov. Arnold Schwarzenegger are still negotiating a new budget, the state's deficit has continued to soar, and Gov. Schwarzenegger has vowed to veto any tax increase.

Children in the state will still receive dental care under the program, but many adults will suffer deeply. "People may die as a consequence of this," said Thomas E. Lewis, D.D.S., a dentist at Northern Valley Indian Health in Red Bluff, CA.

He told the story of a 22-year-old man who came to see him last week. "I look at this guy with a nice smile, no gingivitis, and he has a big hole in No. 3. He was in lots of pain and beginning an abscess. I could have saved the tooth with a root canal, but all I could do for him was extract it." His was the second such case in two days, and Dr. Lewis expects to see many more.

So does Garrick Hong, D.D.S., who works at La Clínica de La Raza. "I think we're going to see a lot of viable teeth get extracted," he said. "A lot of times, especially in the older population, it's going to affect their overall health." The extractions can lead to jaw problems and prevent them from getting proper nutrition, he said.

More than lost teeth

Also lost are patient education programs. "You would be surprised how many people don't know how to floss properly," Dr. Hong said. That will have consequences for patients' systemic health.

The loss of Denti-Cal for adults will cost La Clínica de La Raza about $2 million, or 20% of its budget, said Dental Director Ariane Terlet, D.D.S. One day, 14 patients didn't show up for their appointments. Another day, 16 didn't come.

"We expect people to just come in when they're in pain," she said. "And we'll have to pull the tooth."

Cutting Denti-Cal isn't even likely to save the state money. The state will lose the 40% federal matching funds, and dentists like Dr. Terlet expect a lot more of clinics' former patients to end up in hospital emergency rooms. Physicians there might extract a tooth or simply send the patient home with antibiotics and pain killers. Either way, the state will have to pay some $1,500 for the visit.

"We could have seen 15 patients and taken care of their problems for that $1,500," Dr. Terlet said.

Yanela Onofre might end up costing the state more money in this way. She has a broken tooth, but doesn't know how she will pay for a crown.

"I'll have to get it done because of the pain," she said after getting an examination at La Clínica de La Raza. But Onofre quit work as a housecleaner three years ago after giving birth to a daughter who has asthma. Her husband works as a gardener, but his employer cut his hours back to half time because of water restrictions resulting from the state's drought. Onofre has no plans to go to an emergency room, but she doesn't know how she'll pay for a crown.

Dr. Lewis thinks of these and countless similar stories when he hears some dentists criticizing government programs. "Sure there are some alcoholics and ne'er do wells," he said.

But there are also people like Richard, who comes to Dr. Lewis for dental care. Confined to a wheelchair because he had polio when he was 4 years old, Richard lives on $800 a month.

"Who caused him to have polio?" asks Dr. Lewis, who is also an ordained minister in the Unitarian-Universalist church. "Did he? Did God? It's not so simple."

Either way, Medicaid benefits or not, Dr. Lewis intends to go on helping people like Richard as best he can.

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