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Kentucky reverses itself on Medicaid dental cuts after uproar

July 27, 2018

By David Burger

Frankfort, Ky. — After fierce opposition from many constituents, including the Kentucky Dental Association, the state of Kentucky announced July 19 that it would rescind Medicaid cuts that eliminated dental and other services for nearly 400,000 residents.

“We have begun the process to reinstate vision and dental coverage, as well as nonemergency transportation services, for those whose benefits were affected,” according to a statement from Kentucky’s Cabinet for Health and Family Services.

The Medicaid cuts, announced by Gov. Matt Bevin, came after a federal judge struck down the governor’s plan to substantially overhaul Medicaid by requiring Medicaid recipients to work in able to receive benefits.

The overhaul would have placed about 460,000 "able-bodied" adults in a plan called Kentucky HEALTH. The changes, in a program called My Rewards, would have meant that individuals could earn points toward paying for dental and vision care through work or activities such as online classes and volunteering.

After the court decision, the Cabinet for Health and Family Services said in a statement that immediate cuts in dental, vision and transportation benefits were required "to compensate for the increasing costs of expanded Medicaid" and were "an unfortunate consequence of the judge's ruling."

The Kentucky Dental Association responded forcefully to the initial decision to eliminate dental benefits. Dr. Ansley Depp, president of the Kentucky Dental Association, and Rick Whitehouse, Kentucky Dental Association executive director, said in a July 5 statement, “We are disappointed by the removal of dental benefits on July 1 due to the court ruling. Our continued goal is to work with our member dentists and patients to achieve optimal dental health in all populations. The Kentucky Dental Association remains committed to advocate for the inclusiveness of dental benefits in Medicaid and to partner with the administration to restore those benefits as soon as possible.”

A week later, Dr. Depp issued another statement about how the cuts affected dental providers and their patients: “On Monday, July 2, a patient walked into one of our Kentucky dentist’s office ready for dental work to prepare for a heart procedure.  Imagine his disbelief when he found out that as of July 1, all his dental benefits had been discontinued overnight. In this person’s case, he could not continue with his heart surgery until his oral problems had been resolved. This is a great example of the importance oral matters can have on other health issues.”

Dr. Depp continued: “While we are deeply discouraged by the removal of the benefits and the lack of notice, we are happy to start the conversation on how dental health in our Medicaid population could benefit our entire state. In recent years, the significance of dental health on our overall health has become better known, even as many state governments and even Medicare chose to exclude dental benefits.

"While we think there are better options than the [state] program [and] we would love to see a return of dental benefits for the expansion Medicaid population to ensure dental health. The Kentucky Dental Association asks that as we determine where we go next [where] we consider the health of our patients first and foremost.  When we focus on that, how can we lose?”

In a blog post, the Kentucky Oral Health Coalition hailed the state’s decision to rescind its planned cuts to dental care: “Oral health is an essential component to the overall health and well-being of children and their families. Given our historic issues with poor oral health in Kentucky, we have made strides towards improvement in oral health by increasing access and preventive services. These are reasons why Kentucky Oral Health Coalition executive committee members are glad to see the Bevin Administration’s commitment to restore an essential benefit, such as dental coverage, to Medicaid expansion adults retroactive to July 1, 2018. Receiving routine dental care allows for chronic disease management and early detection of chronic diseases that display symptoms in the mouth. We hope the Cabinet for Health and Families Services continues to emphasize the importance of dental coverage for all Kentuckians throughout Medicaid transitions.”

The cabinet statement said, “Unfortunately, changing benefits and coverage is not as easy as flipping a single switch. As cabinet officials testified, system changes are risky and cannot be made overnight. The cabinet has spent the last few weeks working on a temporary solution for restored benefits to be implemented by Aug 1. In addition, while dental, vision, and non-emergency medical transportation eligibility for those in the Alternative Benefit Plan will not show in the system until Aug. 1, the cabinet is close to completing a manual system work-around that will allow payment of claims incurred by any eligible Medicaid beneficiary for dental, vision, and nonemergency transportation services incurred during the month of July.”

The state also said the Centers for Medicare and Medicaid Services will open a fresh 30-day period for public comment on Kentucky’s proposal to transform its Medicaid program but has not given any clear direction on a timeline or likelihood of approval after the comment period. CMS originally approved the plan in January.

The ADA has a Medicaid provider reference guide and advocacy toolkit available at ADA.org by searching for the name of the guide and toolkit.