Funding to restore partial dental coverage for Massachusetts’ 800,000 Medicaid recipients was among provisions included in the budget proposal lawmakers submitted to Governor Deval Patrick on Thursday.
The new coverage — which insures adult recipients’ front teeth only — prompted praise from some health care advocates, but drew pointed criticism from oral health providers on the exclusion of back teeth.
Lawmakers argue that expanding coverage to recipients’ front teeth, which will cost the state about $6 million, will enhance their appearance and enable them to more easily secure employment. The coverage will include the 12 teeth at the front of the mouth — incisors and canines — but excludes molars and premolars.
Restoring full dental coverage to Medicaid recipients would have cost the state roughly $50 million.
Advocates were split on the provision, with some lauding it and others protesting the exclusion of the back teeth.
“It’s something to celebrate,” said Amy Whitcomb Slemmer, executive director of Massachusetts Health Care for All, a health-care advocacy nonprofit. Whitcomb Slemmer said the organization routinely receives calls from Medicaid recipients who are hesitant to go on job interviews due to damaged front teeth.
Few oral care providers were smiling, however.
“It’s absolutely ridiculous,” said Dr. Richard LoGuercio, a former president of the Massachusetts Dental Society who runs a dental practice in Randolph. “If somebody has a toothache, do they think it distinguishes between a front tooth and a back tooth?”
The majority of cavities, hesaid, occur in the back teeth. Unable to afford fillings, Medicaid recipients will be forced to have back teeth pulled or to wait until they fall out on their own , risking infection.
Unaddressed cavities can cause infection to seep into the blood stream and spread to other parts of the body, causing other disease, he said.
The budget compromise sent to Patrick includes about $12.66 billion in MassHealth funding, a 4.5 percent increase from this year’s funding levels. The funding is $40 million less than the amount included in Patrick’s original budget proposal in January.
The state is required by federal law to offer full dental coverage to children who are Medicaid recipients. However, without the partial coverage, many adults on Medicaid seek dental care from emergency rooms, which costs the taxpayers while failing to address the root of the health problem.
“Emergency room care is the highest cost care you can have and unfortunately you can only treat the pain,” said Whitcomb Slemmer.
“It would come as a surprise to people to know that [dental coverage] had been dropped in the first place,” she said.
Medicaid recipients have been without any dental coverage since the state stripped it from the budget in July 2010.
A lack of access to oral health care is often the cause of deeper health problems, said Carrie Endicott, director of Elm Brook Place, a rehabilitation center for the mentally ill, where the majority of clients are on Medicaid.
The center has had to switch much of its menu to soft foods because many members are unable to chew vegetables and meats, she said. Without treatment for decaying molars, many of her clients remain unable to eat properly and are in constant pain.
“Their teeth are just disintegrating,” Endicott said. “At the very least, fillings need to be covered. Both front and back.”
One oral health professional said the state is at least inching in the right direction by providing partial coverage. “We hope this is the first step in an incremental process to restore all dental coverage,” said Dr. Paula Friedman, president of the Massachusetts Dental Society.