His daughter’s dental care costs so much that Robert Houston balks at figuring out a total, but he’s grateful Arizona is now helping with the bills.
Houston, a retired law enforcement officer, has been taking care of his disabled daughter, Whitney, on his own since his wife died when Whitney was 5. Whitney, who has a rare chromosomal disorder, is now 29. And though she’s covered by Arizona’s Medicaid program for health insurance, until October it was not paying for any of her dental costs.
While critics say it’s not nearly enough, the restoration of a dental benefit for disabled Arizona adults is already making a much-needed financial difference for families like the Houstons. The benefit is hailed as a positive step in a state that offers low-income adults almost no help with oral health.
Since Oct. 1, disabled Arizonans over age 21 whose health care is covered by the Arizona Long Term Care System (ALTCS) have been allowed up to $1,000 per year in dental benefits. The change was initiated by the Legislature during the 2016 budget process, restoring a benefit that was stripped in 2006.
The change has taken some burden off families previously saddled with dental bills when their child turned 21. People with disabilities sometimes don’t have the dexterity to brush their teeth; they frequently take medications that cause dry mouth, a risk factor for tooth decay; and they often need sedation to get even routine dental work.
ALTCS is part of Arizona’s Medicaid program for low-income people, the Arizona Health Care Cost Containment System (AHCCCS).
Yet AHCCCS, which provides coverage to one in four Arizonans, is still lacking adequate dental coverage for adults, says Kevin Earle, executive director of the Arizona Dental Association.
At charity dental events, Earle has witnessed Arizonans with intractable pain due to dental problems they couldn’t afford to fix.
“It’s really sad to see folks, usually the working poor, in situations where they have no dental benefits and nowhere to go but the emergency room,” he said.
Hope in budget
Arizona is one of four states in the country that do not give any dental benefits to the non-disabled adult Medicaid population, the nonprofit Center for Health Care Strategies said in an October 2016 report. The others are Alabama, Tennessee and Delaware.
However, Gov. Doug Ducey’s proposed executive budget for the 2018 fiscal year includes an allocation of $1.5 million to provide emergency dental care for the estimated 850,000 adults enrolled in the general AHCCCS population. Adults on AHCCCS had emergency dental care covered up until 2010, when the state took the benefit away to due to budget constraints.
While children under age 21 enrolled in AHCCCS have both their preventive and emergency dental care covered, non-disabled adults in the general AHCCCS population do not have access to any dental services, including dentures.
One population segment especially affected by that lack of coverage is pregnant women on AHCCCS, health experts say. Physical and nutritional changes that occur during pregnancy raise the risk of dental and gum problems.
Several studies and national guidelines have found a link between gum infection and poor birth outcomes, such as preterm deliveries, lower birth weight and high blood pressure, which can lead to serious complications for the baby.
State Rep. Kelli Butler, a Phoenix Democrat, introduced legislation this session that would have given pregnant women up to $1,000 per year in dental benefits — the same benefit that the ALTCS population is getting. A key part of that benefit is that it can be used for preventive dental care, said Will Humble, executive director of the Arizona Public Health Association.
Humble and other supporters of Butler’s legislation say it’s important to keep mothers as healthy as possible and educated about oral health. If a mom is educated about her own oral health, she’s more likely to have her baby seen by a dentist by the recommended age of 1, supporters say.
Butler’s bill did not advance beyond the House health committee, which passed it unanimously. The measure was supported by the March of Dimes and the Arizona chapter of the American College of Obstetricians and Gynecologists, among others, and would have appropriated $1.2 million from the state’s general fund and $2.9 million from federal funds.
While the bill to cover pregnant women failed this session, Earle of the Arizona Dental Association is hopeful it eventually will pass. “It will probably take several years,” he said. “There are a number of groups very interested in getting it through.”
If Ducey’s proposed emergency dental provision for adults on AHCCCS passes, then pregnant women would at least be able to get emergency dental care. But covering preventive services is better, even though it costs more, Humble said.
Sedation an issue
The dental benefit for disabled adults, which also extends to elderly Arizonans enrolled in ALTCS, could have gone further but is a positive start, says Tucson pediatric dentist Dr. Michael LaCorte, who has a practice in Oro Valley and works on special-needs patients of all ages.
LaCorte says since some developmentally disabled adults can be extremely sensitive about having dental work, they need anesthesia for procedures more often than the non-disabled population. “When you do anesthesia it goes against the $1,000 and can get eaten up pretty fast,” he said. “It would be really nice if they could separate the anesthesia.”
But he said the $1,000 can go to teeth cleaning and provide a small savings over paying cash, too.
“Any help I can get is excellent,” said JoAnn Spencer, who has 26-year-old twin sons with cerebral palsy and other medical issues. “I have not been able to work full-time since they were little.”
Spencer’s sons have not had dental problems, but she’s using the benefit to pay for their twice-annual teeth cleanings with LaCorte.
The benefit is also affording other families the ability to do non-routine work like crowns that they’d been putting off, LaCorte said.
The Legislature added the benefit for ALTCS enrollees, and it’s paid for with $3.3 million in state and county money, plus $7.4 million in federal dollars. Nearly 60,000 Arizonans are enrolled in ALTCS, classified as developmentally disabled, elderly disabled or physically disabled.
Whitney Houston (yes, she was named for the singer, she says) has a rare condition called 9p minus syndrome, which has resulted in some skeletal and jaw irregularities that affected her teeth.
Her dad Robert, 67, said that since everything prior to October was out of pocket, any little bit helps, even though $1,000 doesn’t cover much. Whitney recently got two crowns on her lower teeth.
“We’ve accepted some help pro bono. But that can only go on for so long,” he said.
Earle said dentists in Arizona who work with special populations have seen an increased demand since October due to deferred dental needs. He’s also heard from some families who don’t know about the benefit, and he’s hoping there will be more awareness that it’s available.