For the week of April 17 - 23, 2002

For some, Medicaid cuts could mean no teeth

Dental funding cuts frustrate caretakers

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"The whole mentality of this is beyond comprehension."

— Gail Gogila, Blaine Manor director

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By TRAVIS PURSER
Express Staff Writer

Some nursing home residents who need dentures will likely not be able to get them due to recent Medicaid cuts, but in those cases, nursing homes should grind, puree or blend residents’ food so they can eat, the Department of Health and Welfare informed nursing home managers this month.

The insurance cuts, which went into effect April 1, were mandated by the Idaho Legislature as a budget-balancing measure and, among other reductions, limit dental care for Medicaid recipients over age 21 to emergencies only, unless they are pregnant.

More than 20,000 of Idaho’s poorest residents who rely on the taxpayer-funded Medicaid for dental care are expected to be affected. Seven-hundred Medicaid recipients live in Blaine County. Medicaid expects to save $7 million in fiscal year 2003 from the dental care cuts.

Under the new rules, patients who have trouble with their teeth, and can’t pay privately for dental work, are limited to treatment of problems requiring immediate attention, such as episodes of acute pain in their teeth, gums or palate.

Without preventative care, they might lose teeth that could otherwise be saved, and then have no way of replacing the lost teeth.

Now, "we would probably take (an unhealthy) tooth out," rather than trying to save the tooth by filling it or by performing a root canal, said Dr. Lawrence Child, a dentist in Gooding who provides dental care for the Medicaid residents of the Blaine Manor nursing home in Hailey.

Blaine Manor is struggling to find a way to continue providing non-emergency dental care to its frail and sick Medicaid residents. Regular dental care and the long-term, overall health of residents are linked, said the home’s director, Gail Goglia.

An April 2 letter from the Idaho Department of Health and Welfare added a twist to the new changes by reminding nursing homes throughout Idaho that even though the state has cut funding for routine dental services, federal law requires nursing homes to continue providing it.

Facilities "must try to find an alternate funding source such as family, charity, church, or civic organization that will pay for the services," wrote Debby Ransom, chief of the Department of Health’s Bureau of Facility Standards in the letter.

If that doesn’t work, Goglia said, in all likelihood, residents on Medicaid will not be able to pay for dental services with the $40 per month they are legally allowed to keep from their Social Security checks.

That is especially true for dentures, which can cost around $2,000, Goglia said. Most of Blaine Manor’s residents require them, she said.

Blaine Manor, which operates with a subsidy from county taxpayers and is already financially strapped, will not likely be able to help with the new financial burden, she said.

In her letter, Ransom wrote that nursing homes are not required to pick up the cost of routine dental service, however, if they seek charitable donations, yet fail, then document the effort in the resident’s record.

"In some unfortunate cases where no alternative funding can be found, the resident will go without service," wrote Ransom.

"It is likely that some residents who need dentures will not be able to get them," she wrote. "In these cases, the facility should assess the resident’s need for a mechanically altered diet."

During a meeting Friday, Gail Goglia, Blaine Manor directoer, and Board chairwoman Mary Ann Mix expressed frustration at the letter, which Mix said outlines a "classic unfunded mandate" by the government.

"The whole mentality of this is beyond comprehension," Gogila said.

She said grinding food for the toothless elderly, rather than providing dentures, degrades their quality of life.

"You want to be able to provide the food that is most close to normal," she said.

 

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