Arizona has become the first state in the U.S. to completely eliminate its Children's Health Insurance Program (CHIP). The state's 2010 budget, signed by Gov. Jan Brewer on March 18, shuts down the KidsCare program, which provides medical and dental coverage to 38,000 low-income children.
The KidsCare program, Arizona's version of CHIP, is slated to end June 15, 2010. KidsCare covers children whose families have income between 100% and 200% of the federal poverty level.
— Elizabeth Rogers, Oral Health America
"This is a huge tragedy," Oral Health America spokesperson Elizabeth Rogers said in an interview with DrBicuspid.com. "The state is inevitably going to incur significant costs from this decision, both in their critical care and emergency care units and in other healthcare facilities. Once parents and children are experiencing pain for untreated oral disease, they will be seeking care one way or another, and someone is going to have to pay for it. Their health problems are not going to go away just because these programs are cut."
Arizona does not have enough funds to keep paying its portion of this program, according to the Arizona Health Care Cost Containment System (AHCCCS), which administers the state's Medicaid program. The state is facing a projected $2.6 billion shortfall next year.
But the cuts also mean the state will forgo hundreds of millions of dollars in federal matching aid. The KidsCare program was funded jointly by the state and federal government, which matches state contributions to Medicaid and CHIP programs on a varying percentage based on a state's per capita income. In 2010, 76% of the funding for Arizona's CHIP program would have come from federal matching funds.
"They are leaving a lot on the table by eliminating the CHIP program," said Meg Booth, deputy director of the Children's Dental Health Project (CDHP).
Adult benefits too
Gov. Brewer's 2010 budget also affects adult patients and providers. It reduces dental provider fees by 5% and eliminates Medicaid adult dental services as of September 30, in addition to other dental program changes, according to the CDHP. The state has about 4,000 dentists, including some 1,000 AHCCCS providers, said Kevin Earle, executive director of the Arizona Dental Association.
"The cutting out of this benefit [adult dental services] is extraordinarily short-sighted," said Earle. "These folks are not going to do anything until they have pain, and then they will show up at the emergency rooms, overburden the emergency rooms, probably be prescribed an antibiotic and pain medication, and then discharged. But this will not stop the progression of the infection.
"If we don't invest the money when it is needed," he added, "we will end up with people in the hospital with gross infections, and there are only a limited amount of funds available to offset the costs to the hospital. So ultimately the cost will be transferred to those who can afford to pay in the form of higher hospital costs."
Between the elimination of the KidsCare program and the adult Medicaid services, "the implications are frightening," he said.
"While all Americans understand the tremendous pressure on states to manage their budgets during this recession, the CDHP is deeply concerned that cuts in essential health coverage programs will all too quickly backfire into higher costs for states when former beneficiaries need to obtain emergency care for conditions that could have been prevented or treated earlier and more effectively," added Burton Edelstein, D.D.S., M.P.H., founding chair of the CDHP.
Booth said she is not aware of any other states that are considering eliminating their CHIP programs. Many, such as California -- and now Arizona -- are opting instead to cut adult dental benefits. In contrast, as part of a new federal program, Iowa recently became the first state in the U.S. to implement a dental-only program for underinsured children in low- to modest-income families.
"This is a historic time for state and federal governments in terms of investing in healthcare, and we hope that oral care can become a priority," Booth said. "Significant investments will be made through the passage of the healthcare reform bill that will help states like Arizona, although it doesn't necessarily mean they will be able to restore CHIP and the adult dental benefits. We hope that the potential passage of healthcare reform will not only help states regain some traction on children's health but also provide them with some infrastructure to address children's oral health specifically."
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