The need for dental care for low-income or disabled adults in South Carolina is so severe that people line up 24 hours ahead of time for the one major free care event each year put on by the S.C. Dental Association.
Starting Dec. 1, the state Medicaid agency will begin meeting some of that demand, as for the first time it will provide preventive dental benefits to nearly 300,000 adult Medicaid clients in the state. People 21 and older with full Medicaid benefits will be eligible for cleaning, fillings and extractions, with a $750 per year maximum benefit.
“It will help a lot,” said Dr. Isabel Driggers, who has been frustrated when disabled children she cares for at Coastal Kids Dental and Braces lose their dental coverage at age 21. “It won’t help everyone, but it will be better.”
Last year, South Carolina was one of 16 states that offered only emergency dental benefits through Medicaid, while three other states offered no dental benefits at all, according to the American Dental Association. Twenty other states offered limited benefits similar to the level South Carolina will begin Dec. 1. Twelve states provide what the dental group terms extensive benefits.
The S.C. Department of Health and Human Services, which administers Medicaid, decided to provide the benefit “recognizing that oral health is important in how it impacts the entire body,” said Deirdra Singleton, deputy director of health services.
The payout from the agency for adding the benefit is estimated at $35 million in 2015 and $40 million in 2016, with federal Medicaid dollars covering about 70 percent of the cost. The dental benefit should lead to other savings – and better overall health – for Medicaid recipients. For instance, patients who might have shown up at a hospital emergency room for pain relief from a tooth problem in the past now can get much less expensive dental care.
The state already provides dental care for children in the Medicaid system. The state originally had planned to begin offering the adult dental benefit on July 1, but the process was delayed to work out details. The agency didn’t want to offer a benefit without making sure dentists were available to provide the service.
“We didn’t want to just go out and flip the switch,” Singleton said. “We called providers, knocked on doors, and asked them if they were willing to take additional patients.”
The survey found 42 percent of dentists would take new patients with the Medicaid benefits. With an initial wave of new patients accepted at fewer than half of dentist offices, they might find a long wait for their first appointment.
Demand will be high. In the one year that the SC Mission Midlands’ free health care event included a full range of dental care, the number of people who showed up doubled. People lined up for hours for the dental care, and some simply had to be turned away because their weren’t enough time slots available. Meanwhile, people who wanted only standard medical care faced only short waits.
The Medicaid dental benefit is offered only for adults with full benefits, usually those with very low incomes or disabilities. It isn’t included at the Healthy Connections Checkup benefit level, which covers many other health screenings. The benefit includes a $3.40 co-pay, and the $750 per year maximum won’t cover extensive work.
The new benefit should be especially helpful for adults with special needs. “After they (turn 21) they lose dental benefits,” Driggers said. “It’s really sad. I’ve seen so many families hit by this.”
In some cases, parents are in their 70s or 80s and still caring for a disabled child much older than 21, she said. They struggle just to brush the child’s teeth. Even if they can find a dentist willing to work with the child, they often don’t have dental insurance and can’t afford to pay for the care. At least now, they won’t have to pay for the care if the disabled adult child qualifies for Medicaid.