Lawmakers Again Aim to Establish Adult Dental Benefit Under Medicaid Program | New

Julie Hilliard faces two significant challenges every time her son Cameron, 30, needs basic dental care.

His intense fear of medical procedures, triggered by his severe intellectual disability, autism and epilepsy, requires restraint, anesthesia and treatment in an operating room, even for a cleaning. But before Hilliard can make that appointment, she needs to find a grant to cover what may be a $ 5,000 bill because Cameron’s Medicaid doesn’t include preventative care.

“What’s covered in New Hampshire is that they’ll come in and pull the tooth out,” said Hilliard, of Claremont. “They won’t even clean the other teeth while they’re in there.”

An anesthesiologist offered a solution, telling Hilliard that she should have all of her son’s teeth pulled out and be done. “He might even learn to eat toothless steak,” Hilliard recalls.

Federal law requires that all children receiving traditional and extended Medicaid receive free preventive and emergency dental care and restoration of their teeth. According to the American Dental Association, New Hampshire is one of 10 states that only provide emergency dental benefits to adults. This means that the state will cover tooth extraction for the roughly 85,000 adults on traditional and extended Medicaid in New Hampshire, but none of the preventive care to avoid this extraction.

For the third year in a row, lawmakers are working to change that.

A Senate bill that has received unanimous support in this chamber this year will be back. And a scaled-down version of House Bill 103, which was held up in the last session due to cost concerns, will be presented to the entire House in January with near-unanimous support from the same committee that brought it about. detention. As reworked last week, the bill would provide extended preventive care to adults with the addition of a co-payment for those with incomes above 100 percent of the federal poverty line and a limit for individuals covered by dental prostheses.

The cost is estimated to be around $ 27.5 million, of which $ 20 million is paid by the federal government, which covers half the cost of dental expenses for traditional Medicaid recipients and 90 percent of the cost for those who do. of extended Medicaid.

“I think there is good reason to believe this will pass,” said Rep. Jess Edwards, an Auburn Republican who, like other members of his party, was uncomfortable in the last session. with the price and the absence of co-payment. “If we only get half the Republicans to vote for this, it’s going to pass pretty easily.”

What sounds like broad support, however, does not guarantee success. This advantage died at the finish line before.

In 2019, Governor Chris Sununu signed a bill directing the Department of Health and Human Services to create a plan to provide broad dental benefits to adults. The ministry has assembled a task force of health care advocates and Delta Dental, which has been a strong advocate for expanding benefits for adults beyond just emergencies.

Two years later, plan in hand, lawmakers introduced new adult dental benefits legislation with overwhelming support from the House and Senate. Lawmakers have heard from people like Tim McKernan, the director of policy and advocacy for ABLE NH.

McKernan, of Pembroke, grew up receiving dental care as part of his mother’s insurance plan. When he moved to California in his twenties, he had little money and no dental insurance. A painful wisdom tooth made it difficult to get to work, but McKernan postponed treatment knowing he couldn’t afford it.

When someone told him about a free dental clinic, he waited all day hoping to get an appointment. He did so and went home with the wisdom tooth sticking out and without a bill. “It was just the feeling of vulnerability and uncertainty and not knowing if I was going to be taken care of or what was going to happen to me,” he said. “I knew dental infections were dangerous and could lead to death. “

When the bill reached Gov. Chris Sununu’s office in July 2020, the state was four months away from the pandemic. Sununu vetoed it, citing concerns over spending $ 11 million as the state navigated economic uncertainty. In his veto message, Sununu said he supported the concept and hoped that more work would produce an affordable and sustainable plan: “If so, we can implement a benefit at a time when the state has the financial resources to do so in a cost-effective manner. “

Gail Brown, director of the New Hampshire Oral Health Coalition, remembers that day well.

Brown had begun his advocacy for adult dental benefits almost two decades earlier and had spent those early years educating lawmakers on both sides of the link between poor oral health and dozens of other diseases, heart disease and birth complications to Alzheimer’s disease and osteoporosis. Under the leadership of Senator Jeb Bradley, a Republican from Wolfeboro, Brown and his fellow advocates called it a big win when lawmakers came to view oral health as overall health. She was devastated to see the bill vetoed.

“It was like someone was shooting at you because we had worked together for so long,” Brown said. “There was bipartisan and unanimous support in the Senate. There was overwhelming support in the House. To keep that from happening, it was like having a hole in your heart. “

Dental benefits returned in 2021, with bills introduced in the Senate and House.

During the Senate public hearing, 255 people signed on to support the bill and one to oppose it. The bill was passed by the Senate 24-0. The House bill received similar overwhelming support – 131 for, seven against – but was retained in committee. An unexpected last minute disagreement over the cost of extending dental benefits could not be resolved until the end of the session.

Rep. Keith Ammon, a Republican from New Boston, was among seven to oppose the House bill. He said in an email last week that he supported the amended version because it includes cost sharing and a stricter requirement for health and social services to provide a legislative oversight committee with an annual report on the uptake of benefits, involvement of dental providers and other indicators of program effectiveness. “Better reporting helps ensure that program costs do not become unsustainable,” he said.

Ammon also said he believed the original bill was too expensive and unsustainable. “The amendment strikes a better balance between ensuring that the most vulnerable receive dental care and respecting those who pay for dental care out of pocket,” he said.

Limiting dental care and adding a copayment could be a tough sell to some legislators and oral health advocates who have worked for more than a decade on this issue.

Dentures will only be covered for residents of nursing homes, adults with developmental or acquired brain disorders, and Medicaid beneficiaries who receive medical and other services at home under the federal Choices for Independence program. . Adults receiving expanded drug addiction Medicaid services would not be included unless they fell into one of these categories.

Edwards said the 5-10% copayment of a dental bill would provide benefits to those who need it most but can least afford it, while keeping taxpayers in mind.

“It’s out of respect for taxpayers who don’t get free dental insurance,” he said. “You may have the option of paying for dental insurance, but it’s not free. So while a Medicaid beneficiary would not pay the same rate as a taxpayer under a commercial program, we felt it was important to let the taxpayer know that the medical beneficiary is also paying for a benefit. similar.

Representative Joe Schapiro, a Keene Democrat who sits on the House’s health, social services and seniors’ affairs committee, was reluctant to support the amended version. During his years as a social worker and psychotherapist, Schapiro saw clients who suffered greatly because they could not afford dental care. He recalled one, a single mother on Medicaid, whose benefits covered dental care for her children but not hers. She used to pay for root canals and caps with a credit card and dental plans, which often come with high interest rates.

Schapiro fears that even a small 5-10% stake in a service, the maximum allowed by Medicaid, may be out of reach for some and cause them to forgo dental treatment.

“My concern is that it doesn’t save a lot of money and it reduces usage,” he said. “What we want to do is improve public health and get these people to go for the most important thing, which is preventative service, then restoration service, and then go out and get dentures so that ‘they can find a job and quit Medicaid. “

Compromise is a step in the right direction, he said, but a difficult one to take.

“I had to really struggle to accept cost sharing, which in principle I don’t think is a good idea,” he said.

When the committee holds a public hearing on the amended bill, Hilliard will likely be back to tell Cameron’s story and advocate for extended dental benefits.

“Cameron doesn’t have a voice and he’s functioning mentally at a 2-year-old level. He doesn’t understand what we’re doing for him,” she said. “He’s completely helpless. It’s inconceivable that he This is acceptable dental practice – just pulling your teeth out one at a time until they are all gone, and that is what they consider “care.”

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