For adults with developmental and intellectual disabilities, preventive dental care is hard to come by. Few can afford the out-of-pocket expenses — and many end up with no teeth at all.
House Bill 172, sponsored by Rep. Rhonda Butler, R-Ville Platte, seeks to fix that by requiring Medicaid to cover routine dental care for those 21 and older with such disabilities. It sailed through the House Committee on Health and Welfare on Tuesday.
Under current law, Medicaid offers adults with disabilities limited coverage for tooth removals, dentures and hospital visits tied to dental emergencies.
Without routine check-ups, dental issues among disabled adults often go unnoticed. Verbalizing tooth pain can be difficult for those who are developmentally disabled.
The expansion would increase Medicaid expenditures by $17 million, with $11 million coming from the federal government — though Butler said that covering preventative dental care could save the program money in the long run.
One woman racked up $500,000 in hospital bills and had to get a lung removed after breathing in bacteria from an infected molar that went undetected, Butler said.
"They have to land in the hospital with a medical problem before Medicaid pays for it," Butler said. "If we start with preventative care, we don't land in those emergency rooms."
Mary Kay Cowen's brother Tommy is 62 years old but has the mental capability of a 12-month old and the motor skills of an 18-month old. A few years ago, his limbs began to swell, so doctors gave him antibiotics. Still, the source of the infection remained a mystery.
It wasn't until a rare dental visit months later that Cowen learned her brother needed a root canal. Once the tooth was pulled, the swelling subsided.
"Tommy couldn't tell us," Cowen said. "I can't imagine how long this man lived with that pain. I felt like I failed my brother, to be honest"
The measure is only the first step in improving dental care for disabled adults, advocates say. There's still a shortage of dentists and facilities that can provide the specialized care required.
Kathy Dwyer's daughter, Jennifer, has problems allowing doctors to examine her orally. She had to pay $3,600 to put her under general anesthesia just to receive a routine teeth cleaning.
Butler, who has a son with special needs, called the status quo of pulling teeth and providing dentures "inhumane." She noted that many of the adults who receive dentures don't understand that they need to keep them in place and end up chewing their food improperly. That can land them in the hospital with intestinal issues.
HB172 would cover diagnostic, preventative and restorative dental and oral health services, as well as endodontics, periodontics, prosthodontics, oral and maxillofacial surgery, orthodontics and emergency care. More than 10,000 adults with developmental and intellectual disabilities are enrolled in the waiver program that would be covered.
The legislation does not include those adults who reside in intermediate care facilities, though a companion measure, House Continuing Resolution 34, asks the Department of Health to study how such a measure could be financed through the existing funding formula.