Dental Health Cuts

As of July 1, 2010, about 700,000 Massachusetts adults lost much of their dental coverage through the MassHealth Dental Program, the public health insurance program.¹ No longer will the approximate 130,000 elders of this population receive crucial services such as fillings, crowns, root canals, dentures, and other restorative services, such as gum disease.² With these cuts taking affect, the only remaining coverage for members of the MassHealth Dental Program is for check-ups, cleanings, and extractions. Such a cut reflects the Patrick Administration’s desire to cut more than $800 million³ from next years state budget as such an elimination of adult restorative dental care will save the state upwards of $56.3 million.⁴

Although dental services may appear secondary to primary healthcare, “oral health is an important part of overall health for both children and adults…[as] there is extensive evidence that oral disease, if left untreated, can lead to other medical problems which require costly treatment and put the patient's health at risk.”⁵ As applied to the cuts, without dentures, thousands of low-income seniors will be unable to eat the foods they need to stay healthy. Further, without fillings, dental decay cannot be stopped from spreading throughout the body. Interestingly and sadly enough, elders who actually need such dental services are often the least likely to afford them. According to the Centers for Disease Control and Prevention, “older Americans with the poorest oral health are those who are economically disadvantaged, lack insurance, and are members of racial and ethnic minorities. Being disabled, homebound, or institutionalized also increases the risk of poor oral health.”⁶ Additionally, in order to even qualify for MassHealth a single elder’s income must be less than $11,000 a year. If an elder needs a full set of dentures, “a conservative estimate would put the cost in the neighborhood of $3,000 or about a third of her total yearly income.”⁷ Not only is it problematic that elders who are most likely to need dental services are the least likely to afford them but also in many instances, qualifying for the now more restricted MassHealth Dental Program is extremely difficult for a struggling elder. In addition to low-income seniors, the cuts significantly impact the thousands of homeless individuals in the state. Since the program no longer covers fillings and procedures such as root canals and bridges but does cover extractions, many have argued that teeth that could be saved through root canals or other procedures will instead be extracted.⁸ Additionally, without fillings, the homeless will be at a heightened risk of dental decay and disease, further exacerbating the health problems associated with homelessness. Daily life for [the homeless population in Massachusetts] was difficult enough “before these cuts…Losing these services is devastating.”⁹

Such cuts affect not only the elder and homeless populations of Massachusetts, but also local dentists. Dentist Barry Aston of Hudson, Massachusetts has argued that the MassDental program played a crucial role preventing costly trips to the hospital due to dental emergencies. Further, such cuts affect his livelihood: “I will be losing around $60,000 with the cuts to MassDental, so I have a personal interest vested in this.”¹⁰

On a larger economic level, many legislators have argued that such dental cuts detrimentally affect the state’s overall economic condition – State Representative John Sciback has argued “the bottom line is if people don’t get consistent dental services, the state loses more money.” Further supporting this assertion, the Oral Health Advocacy Task Force Of Massachusetts suggested in a recent press release “the long term cost of eliminating adult dental care is 2.5 times more expensive than the cost of providing care.”¹¹

With such detrimental effects, it should logically follow that the MassDental Health Program should be restored as it was prior to July 1, 2010. However, such a restoration is determined by the amount of monetary funds available. There is hope however, through the upcoming federal funds coming to the state. According to Health Care For All, the state will be receiving additional revenue from the federal government through FMAP funds.¹² Such funds could and should restore critical services for an already vulnerable population.

Namita Agarwal is AyerHoffman's Health Law & Policy Contributor. Ms. Agarwal is currently a J.D. candidate at Northeastern University School of Law where she concentrates her studies on domestic and international health care, welfare, and immigration law.