Temple University’s 10,200-seat Liacouras Center is normally reserved for Owls basketball games, rock concerts and commencement ceremonies. But last weekend, it was transformed into a giant dentist’s office, right down to the antiseptic smell.
About 1,800 people received free treatment, some standing in line overnight to access care. Dentists donated a total of $1 million in services on Friday and Saturday, doling out free cleanings, fillings and root canals as patients waited in the bleachers. But even with 120 chairs set up across the arena floor, hundreds were turned away.
It’s no coincidence that the nonprofit MOM-n-PA Dental Missions’ first-ever two-day dental clinic in North Philadelphia took place less than two years after the Corbett administration drastically reduced dental coverage for adult Medicaid enrollees.
“There’s almost no coverage in Pennsylvania,” said Bernie Dishler, an Elkins Park dentist and an organizer of the event. Medicaid patients, for instance, “can only get dentures once in a lifetime,” which puts them at risk of oral cancer, he said. Root canals, periodontal care and crowns are no longer covered. The reduction in Medicaid benefits was introduced in fall 2011 and phased in by managed-care organizations (MCOs) over the past year or so.
Many waiting for service on Friday were among the working-poor Philadelphians who have no dental coverage at all. David Brewington receives no health insurance from his temporary jobs. A father of two, he had left a chipped tooth unattended for two years, until it started to decay. When air gets in, he said, “it’s like someone jamming at your nerve.” Yasmine Fainasworth said she could not afford her employer’s health insurance. She got in line at 5:30 a.m. to get a root canal, for a tooth that kept her awake at night. If she hadn’t made it to the clinic, her only option to fix it would have been to “win the lottery.”
The Department of Public Welfare (DPW) estimates reducing dental-care coverage has saved the state $18.6 million. Those who are denied coverage for procedures can petition for expanded benefits. In the second half of 2012, MCOs received 8,300 such applications. Only 16.7 percent of those were approved. In that time, one MCO, United Healthcare, approved just 0.6 percent of applications.
“There has been a tremendous amount of leeway given to the [MCOs],” says Kyle Fisher, attorney at the Pennsylvania Health Law Project, which regularly hears from affected Medicaid patients.
Last year, City Paper spoke with Anthony Lomax, 66, a North Philly man who, because Medicaid wouldn’t cover partial dentures, had all his teeth pulled — and then was denied coverage for a full set of dentures under the new guidelines. CP checked in with Lomax recently: He says he was toothless for five long months. “I went through hell,” he says. “I couldn’t eat, for one thing, and my gums used to bleed.” With help from Community Legal Services, he appealed and finally received dentures. He says he never could have navigated that system alone.
Fisher says one problem is that patients cannot submit exception requests themselves. Instead, a dentist must submit the application, which often requires the support of a physician because the standard is “serious deterioration of health.” One client lost 35 pounds because she, like Lomax, was refused dentures. It took a year to get her benefits approved.
For others, though, the problem isn’t the lack of coverage, but limited access to care. Many dentists simply won’t accept Medicaid, because they say government reimbursement rates are too low. “Even in places like Philadelphia, which has a lot of dentists, it’s hard for adult Medicaid patients to get treatment,” says James Eiseman, senior attorney at the Public Interest Law Center of Philadelphia.
Dentist Bruce Terry, a MOM-n-PA board member, said his insurance reimbursement rates had gone up by less than 3 percent in the past five years. He does not accept Medicaid.
The multilayered system of MCOs, which in turn may have subcontractors for dental care, has kept much of the information on reimbursements under wraps.
Since 2011, the Public Interest Law Center of Philadelphia has filed two Right to Know requests and multiple appeals to find out why only a third of children enrolled in Medicaid received dental services in 2009. Eiseman said the question is how much the state is paying to MCOs — and how much of that money is going to dentists. DPW refused to disclose the reimbursement rates, which it termed “trade secrets.” The state Office of Open Records twice ruled in favor of the law center, but the data was never released.
DPW does not regulate the fees MCOs pay. But Fisher says it has a responsibility “to take its oversight role seriously. … To make sure Medicaid patients are able to get medically necessary services — that is the issue.”
Additional reporting by Samantha Melamed.
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