Almost half a million low-income Illinoisans soon will be able to receive periodic exams and teeth cleanings while paying, at most, a few dollars out of pocket.
That’s because preventive dental care for adults has been added to the state’s Medicaid program as a covered service for the first time.
The addition was part of a bipartisan agreement on the fiscal 2019 state budget that was signed into law recently by Gov. Bruce Rauner. The dental coverage expansion is expected to cost the state an additional $8 million to $12 million per year, half of which will be reimbursed by the federal government.
“The idea is to get the care earlier, when it is cheaper,” said Greg Johnson, executive director of the Illinois State Dental Society.
Most of the 1.7 million adults in the state’s Medicaid program already get coverage for preventive dental services through managed-care organizations (MCOs). The MCOs have voluntarily paid dental offices for preventive services such as cleanings and sealants but haven’t been specifically reimbursed for those services, Johnson said.
MCOs will receive reimbursement for preventive dental care going forward, but the legislation will have the biggest immediate impact on the 450,000 adult Medicaid recipients who aren’t in managed care, Johnson said.
These adults are in the traditional “fee-for-service” Medicaid program. For them, preventive dental services were treated as uncovered. As a result, they have had to pay much more than $3.90 — the current Medicaid co-payment, when applicable — for cleanings and checkups, Johnson said.
Many adult Medicaid patients in the fee-for-service program avoid preventive care altogether, leading to tooth decay and other problems that necessitate fillings and extractions — services that the state’s Medicaid program does cover, he said.
Preventive dental services for children on Medicaid already are funded by the state.
The expected savings incurred by avoiding or delaying costly restorative services for adults, not to mention the ability to avoid emergency room visits for adults with dental pain, will more than offset the new cost for preventive services, according to state Rep. Greg Harris, D-Chicago.
Preventive dental services for adults will be reimbursed to participating dental offices at the same boosted levels as the rates previously required for children’s preventive services under a 2005 consent decree in the Memisovski vs. Maram court case.
These higher rates could persuade more Illinois dentists to accept Medicaid payments, Johnson said.
About 2,800 of the state’s 9,000 regularly practicing dentists participate in the Medicaid program, he said.
Dr. Mary-Margaret Looker, director of the dental program at Central Counties Health Centers, said the expanded Medicaid coverage will have a “great impact” on CCHC’s adult patients and will keep CCHC’s six dentists and four dental hygienists even busier.
Central Counties is a federally subsidized organization based at 2239 E. Cook St., Springfield, where 70 percent of patients are enrolled in Medicaid.
Even though dental care for uncovered services costs CCHC patients about $25 or $30 per visit — a modest fee compared with private dental offices — the charge is enough to discourage many adults from seeking care, Looker said.
“Now that preventive services are going to be covered, there will be one less hurdle for patient care,” she said. “Having the adult preventive services also will address problems early and save money in the long run. This also may increase compliance from the entire family. Adults and their children can come together for their routine dental checkups.”
Amy Brewer, office manager at Optim Dental, 907 S. Sixth St., Springfield, where 85 percent of the patients are on Medicaid, had a similar reaction to the expanded coverage that is expected to take effect later this year.
“This is a fantastic thing that they’re going to cover cleanings,” Brewer said.
Optim already charges a reduced out-of-pocket rate for cleanings — $89. Cleanings from other private dental offices can cost $100 to $200.
“A lot of patients want to get preventive care, but they can’t,” Brewer said.
Contact Dean Olsen: dean.olsen@sj-r.com, 788-1543, twitter.com/DeanOlsenSJR.