State House and Senate proposals to restore Medicaid dental coverage for more than 200,000 eligible recipients — after state funds were stripped 13 years ago — have received universal written support from state agencies, Hawaii’s major health care organizations, private dentists and their associations, medical clinics in Waianae and Waimanalo, and social service agencies serving the needy, seniors and the disabled.
Three levels of dental care coverage are under consideration. But several people and organizations advocate coverage for the greatest number of services — and for funds to be placed back into the state budget to ensure long-term dental care, which they say could avoid more serious health issues, risk of death and better outcomes for vulnerable infants.
The state funds would be augmented by federal money under the latest versions of Senate Bill 1294 and House Bill 1754.
Under the most expensive proposal, the state would contribute $16.1 million, with an additional $31.3 million from the federal government.
Several written testimonies in support cited studies that showed that limiting Medicaid dental coverage to just emergency extractions and pain management in 2009 caused both emergency room dental visits — and costs — to soar, especially among Native Hawaiians and people living in rural and some neighbor island communities.
Dr. Don Sands, who is helping to organize support for passage of both bills, lives in Hauula where he sees kupuna with abscesses or extracted teeth who are unable to eat anything other than poi at keiki luau.
Thirteen years of bare-bones dental care means that Medicaid patients show up in emergency rooms with more serious problems and are treated by emergency room physicians, which only drives up the cost of health care, Sands said.
“Physicians are paid a lot more than a dentist,” he told the Honolulu Star-Advertiser. “How did we drop the ball? We’re allowing them to walk around with chronic infections … that can affect their heart, their livers, their kidneys, which are being compromised every day.”
‘Ohana Health Plan submitted testimony that the 2009 Medicaid budget cut left Hawaii as one of 13 states that provide only emergency extractions and pain management.
Rachel Wilkinson of ‘Ohana Health Plan cited a 2012 state Health Department oral-health study that listed more than 3,000 emergency room visits in Hawaii “for preventable dental problems, resulting in $8.5 million in hospital charges.”
Dr. Melanie Maykin, a maternal-fetal physician, treats patients with high-risk pregnancies, and wrote in testimony that “dental disease is a known risk factor for obstetric complications including preterm birth.”
She said she treated a 30-year-old diabetic patient who gave birth almost three months early, requiring the newborn to go into neonatal intensive care.
“The only identifiable culprit that triggered the (diabetic ketoacidosis) and possibly in turn, the pre-term labor, was a tooth infection,” Maykin wrote. “The patient had a history of tooth infections but the resources for her dental care were limited.”
The Hawaii Medical Service Association submitted testimony that proper dental care “can decrease potential health care complications for individuals living with chronic diseases, such as heart disease and diabetes.”
Nancy Partika, the Hawaii grassroots representative for the Oral Health Progress and Equity Network, wrote in testimony that adult Medicaid beneficiaries represent “about 25% of Hawaii’s population, but they are 47% of all dental services provided” by Hawaii emergency rooms.
“We now recognize that not intervening in oral health conditions early and preventively will cost much more later on in unintended direct and indirect costs,” Partika wrote.
She cited a 2021 study by the Hawaii Oral Health Coalition and University of Hawaii’s John A. Burns School of Medicine that found that between 2016 and 2021:
>> A total of 29,536 emergency room patients — age 21 years and up — were treated for dental-related issues.
>> Nearly half of those patients — 49% — were Medicaid recipients 21 years and older.
>> Native Hawaiians/part Native Hawaiians represented 24% of the emergency room dental visits.
>> An average of 10% of emergency room dental patients visited twice in the same year.
Jerris Hedges, dean of the UH medical school, wrote in testimony that “223,438 adult Medicaid recipients have no diagnostic, preventive, or restorative dental coverage.”
Medicaid dental patients with chronic diseases such as diabetes and heart disease are at greater risk for “disability and death,” Hedges wrote.
In his own testimony, Sands said that simple dental issues like a cavity can become complicated and cause more serious health problems if untreated.
“If the cavity is fixed early it could have a low-cost treatment such as a simple filling,” Sands wrote in his testimony. “But if untreated this simple problem will continue to damage the tooth and could result in a root canal, a crown, a gum surgery that could cost $3,000 or more. … If the finances are still not available at that point then the tooth is most often removed. … This sad scenario can be repeated as 32 nightmares for the patient as each tooth that can be saved is lost.”
