Dental benefits for poor adults in Missouri remain in limbo

Low-income Missourians feeling the sharp stabs of tooth pain remain in limbo three months after the start of a budget year expected to provide them dental coverage for the first time in a decade.

Lawmakers fought hard to get $14 million for Medicaid dental care coverage in the budget this year, especially afterGov. Jay Nixon previously withheld money for these services because of anemic state revenue concerns.

The money could provide access to dental care for about 250,000 low-income adults for the first time since 2005, when they were stripped of these services as part of Medicaid cuts by Gov. Matt Blunt. Currently, Missouri’s Medicaid program only reimburses dental services for recipients who are children, pregnant, blind or live in nursing homes.

But state officials say they can’t move forward with the program until Nov. 30 at the earliest, because lawmakers tied funding for the dental benefits to revenue gained from tax amnesty. Tax amnesty is a one-time grace period that began Sept. 1 for delinquent taxpayers. It’s expected to bring in about $60 million for the state.

The state has received about $1 million so far, but Department of Revenue officials expect the amount to greatly increase as the Nov. 30 deadline approaches.

When asked if the state was putting plans in place for the dental program in anticipation of funds, Rebecca Woelfel, spokeswoman for the Department of Social Services, said in an email “it would be premature to speculate on possible changes to the program.”

It’s not an answer Rep. Sue Allen, R-Town and Country, likes to hear. Allen is chairwoman of the House Select Committee on Social Services.

“They know we’ve put that (money) in the budget so at this point it would be nice if we knew a plan of what the process would be,” Allen said. “They may not know the (amount of money), but I would hope there is a process being put together so that, at the end of the period, we know what was brought in and then we can fill in the numbers.”

Woelfel would not say if the department, which oversees the Medicaid program, would need to submit a plan for program approval to the federal government.

Funding for the dental program is further complicated by the fact that additional programs were earmarked to receive a slice of the tax amnesty pie.

For example, increases in rates for providers of mental health services, in-home care and nursing home care depend on delinquent taxpayers taking advantage of the grace period.

But once the money comes in, it will be up to Nixon to decide how the funds are distributed and prioritized among the different programs.

What that prioritization will look like is unclear. Scott Holste, Nixon’s spokesman, said in an email that determination will be made “in a fiscally responsible manner” after the money is available.

Holste noted that Nixon called the Legislature to “pursue a more efficient and effective method” of expanding Medicaid coverage, referencing his push to add 300,000 Missourians under the Affordable Care Act.

Medicaid expansion, however, has consistently been a nonstarter with the Republican-led Legislature.

A lack of funds in the adult dental program could affect a dental clinic new to St. Louis this year. A $23 million, 79,000-square-foot facility opened in June near Lafayette Square as a partnership between A.T. Still University and Affinia Healthcare.

The clinic, expected to serve 11,375 patients annually and employ 85 staffers, is part of a program between the university and the Missouri Primary Care Association to train more dentists.

But Joseph Pierle, executive director of the Missouri Primary Care Association, said there is a concern that not enough students would stay in the program or even in Missouri after graduation without Medicaid funding for adult dental services.

“Obviously, if a patient comes in with financing behind them, we’re able to hire more dentists,” Pierle said. “If it’s not reinstated, the students may go elsewhere.”

Source: http://www.stltoday.com/news/local/govt-and-politics/dental-benefits-for-poor-adults-in-missouri-remain-in-limbo/article_cb199be3-09f4-53f3-b701-37b73268b716.html

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