Shaw: Medicaid takes a bite out of patients’ health

Evidence shows that when states seek to make cuts to their budgets, dental coverage for patients is among the first on the list to limit. Concern for these patients’ health and well-being is disregarded despite pain or infections they might have to deal with because of rejection from their health-service coverage. Coverage must change.

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Shaw: Medicaid takes a bite out of patients’ health

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Braces are tricky. Some people want them to simply make their teeth look better for pictures and overall improved self-confidence — a smile says a lot about a person. Others need braces because without them, their dental health is put at risk. Personally, both reasons apply to why I both want and need braces. I recently went to a consultation with my dentist because I had had an infection weeks before because of the crowding in my lower set of teeth. It hurt so bad that just eating and drinking were painfully difficult tasks.

The doctor gave me antibiotics to reduce the inflammation and strong doses of ibuprofen to manage the pain. He told me I needed braces to fix the problem.

When I went to get a consultation for braces after that, the dentist said I needed braces. However, she pointed out that my insurance, Medicaid, would most likely not foot the bill because of coverage changes made in 2016 make it incredibly difficult to prove that someone needs braces — not merely wants them.

I currently am an Illinois resident. Two years ago, my dentist said Medicaid revamped its dental-coverage specifically for braces because of cuts in the state budget. My dentist said she and other dentists lobbied to prevent that decision but
ultimately failed. As a result, most of her patients have been turned down for braces because Medicaid won’t cover it under the point system it has in place — the HLD Score sheet for Illinois and the Salzmann Index for Iowa.

In Illinois, patients must score a 28 on the sheet to be eligible for braces. At maximum, I can score an 11, even though I desperately need braces, according to both of my doctors. In Iowa, the Salzmann Index requires patients to score 26. This means it’s virtually impossible to qualify for Medicaid financially covered braces in both Illinois and Iowa, despite clear need for them because of health concerns. This unreachable scale is disappointing and intolerable for those under Medicaid insurance, and it illustrates just how
much health care in our country needs to change.

According to the National Center of Biotechnology Information, researchers in 2016 found consistent “evidence that when states have faced budgetary pressures, adult dental services in Medicaid have typically been among their first cutbacks.” This evidence along with the recent revamping of Medicaid dental coverage sheds a light on how disappointing health coverage is in our nation. Patients who clearly need treatments such as braces are being denied coverage at any capacity, despite clear health concerns. People are being forced to pay out of pocket for procedures they need just to maintain their health or avoid endangering themselves.

To put things into perspective, braces run up to $4,000 today. Forcing families to pay that price out-of-pocket when they have low incomes just seems wrong — it’s unattainable, not realistic, and it puts their financial security at risk for something they need just to be healthy.

The revamped dental coverage of Medicaid is unfair and makes it extremely difficult to attain necessary health benefits. The score that needs to be reached on the scales for dental coverage must be lowered to something much more attainable, because patients’ health shouldn’t be disregarded merely because of the state’s lack of money.

Medicaid recipients shouldn’t have to make the decision between going into debt or enduring a lifetime of pain and insecurity.