ADA News

Scottsdale, Ariz.—There was a tense period where thousands of low-income adults and children in Arizona were going to be without health insurance, but the governor and legislature were forced to remedy the situation.

Because of the federal health care reform bill, Arizona politicians had to reinstate cuts made earlier this year to the state's Medicare and Children's Health Insurance program.  A clause in the federal health care bill called "maintenance of effort" requires states to keep the health program they currently have or risk losing billions of dollars in federal funds.

"We're extraordinarily happy that it was reinstated," said Kevin Earle, executive director of the Arizona Dental Association. "We just have to watch and make certain that they don't attack any other benefits or trim them back."

In March, Arizona's legislature and governor approved a budget that would drop about 310,000 people from its state Medicaid program and eliminate KidsCare, its Children's Health Insurance program covering an estimated 38,000. The move, designed to offset a nearly $2 billion shortfall, would have made Arizona the first state to eliminate its children’s health insurance program and drew criticism from children's advocates and the Arizona Dental Association.

In a statewide referendum held May 18, Arizona voters passed a three-year 1-cent increase in the state sales tax, to 6.6 cents on the dollar. A portion of the total revenue, projected at $1 billion, is expected to help maintain health care programs, while the rest is dedicated to education and public safety, Mr. Earle said.

The threat of eliminating dental coverage for thousands of low-income children, combined with a cut of the adult dental benefit, left Mr. Earle and members of the Arizona Dental Association scrambling for a response last month. By taking away dental coverage, Mr. Earle and others feared minor oral problems would become serious, possibly leading to more costly trips to the emergency room, or more serious complications.

"We're always distressed when we find there are cuts in reimbursement," Mr. Earle said. "We don't want to get into a situation where kids and adults suffer from pain and infections because they can't be treated in a dental office."

Emergency rooms are not generally staffed with dentists, so the physicians will typically prescribe antibiotics and pain medications but won't be able to treat the underlying dental condition, he said. The ER visits will also translate into higher costs for hospitals since the families without Medicaid coverage won't be able to afford to pay for them, he said.

"When (families) are uncovered, it becomes uncompensated care for the hospitals and it becomes an increasing challenge for hospitals to function when they're not reimbursed for the services they provide," Mr. Earle said.

The Arizona Dental Association was also in a difficult lobbying position because adult dental benefits were eliminated along with a list of procedures such as lung or liver transplants.

"It's hard to argue, even if we had the opportunity to argue, that you shouldn't cut the dental benefit when significant other medical procedures have been cut as well," Mr. Earle said.

Arizona's Medicaid system, run by the Arizona Health Care Cost Containment System, is provided to poor residents who meet the income requirements. To qualify for Medicaid coverage, a family of four must have an annual income of less than the federal poverty level of $22,050, according to the state government Web site.

Families with a higher income level but who are still struggling can enroll in KidsCare to receive coverage for their children. A family of four must have an annual income of between 100 and 200 percent of the federal poverty level and pay a monthly premium. Even before the Arizona legislature passed its budget cutting KidsCare, the program was not enrolling new children, and new enrollments continue to be frozen.