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Amy and Edwin Benson carry plastic flossers in their pockets to keep food from settling in the holes in their teeth. With several untreated cavities each -- and no dental benefits to cover the fillings they need -- they're doing their best to prevent a nasty infection.
"We're just trying to stave off any worse problem," said Amy, 43, who has ankylosing spondylosis, a kind of arthritis. "It's frustrating."
The couple, who have six children, lobbied their state representatives last spring to preserve Medicaid enrollees' dental benefits. But their message went unheeded.
The Legislature didn't appropriate money for dental coverage for aged, blind and disabled Utahns on Medicaid in fiscal 2010, leaving a total of 40,000 people to rely on already overburdened non-profit organizations and safety net clinics for care. The group includes adults between the ages of 19 and 64, with the exception of pregnant women.
At the Maliheh Free Clinic, for instance, there is a four-month waiting list to be seen by the one retired dentist who works there once or twice a week for three hours, said office manager Susan Valenti. And the only service he provides is simple extractions.
Salt Lake Donated Dental Services, meanwhile, changed its first-come, first-served policy to a lottery system in March because people were camping out overnight to improve their chances of being seen that day, said Stephanie Jensen, the clinic's executive director.
Now they show up twice a day, at 8:45 a.m. and 1 p.m., to scribble their name and date of birth on a scrap of paper in the hope they'll be chosen. Still, as many as 60 people are turned away daily, Jensen said, and must come back to try their luck again.
With the recession in full swing, the clinic has seen its caseload nearly double since August, Jensen said. That, coupled with the July 1 Medicaid cuts, prompted it to start a new discounted dental program two weeks ago for people who live at or below 200 percent of the federal poverty level. Instead of participating in the lottery, they can make an appointment to be seen Monday through Wednesday for services offered at a significantly reduced fee.
William Ng was among those taking advantage of the new program Tuesday. The 73-year-old West Jordan man, who gets his teeth cleaned at Salt Lake Community College by students for $5, learned at his last visit that he has five cavities.
Unable to afford care at a private dental practice, Ng was able to make an appointment through the discounted dental program and get his fillings for about $200.
"This place is a great place," he said. "It gives me security."
Jensen said there are seven other safety net clinics in the Salt Lake Valley, but they'll only take those Medicaid enrollees who still have benefits -- pregnant women and children.
Even those populations are stuggling to be seen, however, since provider reimbursement rates were also rolled back July 1. Lincoln Nehring, Medicaid director for the Utah Health Policy Project, said a number of pediatric dentists -- who have seen a total 25 percent reduction in their reimbursements since October 2008 -- have indicated they can no longer afford to see Medicaid patients.
A recent Utah Medical Education Council report on the dental work force showed nearly three-quarters of the state's 1,075 dentists reported in 2006 that they would not accept new Medicaid patients, citing low reimbursement and missed appointments as the major reasons.
"We don't have any (new) data yet on how many doctors or dentists have left the Medicaid market, but it is a big fear right now," said Nehring, whose organization lobbied the Legislature -- unsuccessfully -- to allocate $250,000 for emergency dental services in fiscal 2010.
Congress, as part of its health reform efforts, is considering revamping the Medicaid benefit package to include services, such as dental, that have been considered "optional," Nehring said. Barring that, however, advocates plan to return to the Legislature to fight for their restoration.
"It would be so much cheaper (for Medicaid) to cover basic stuff than to wait until somebody is in the hospital with an infection because they have an abscess," Amy Benson said. "It seems really short sighted to not cover that and expect people to get back on their feet."
Barbara Toomer, secretary of the board for the Disabled Rights Action Committee, agrees. The group rallied outside Senate chambers in early March in an unsuccessful bid to preserve Medicaid dental benefits for the aged, blind and disabled.
"Prevention is the key in any dental or medical area,"Toomer said. But "for some reason, this Legislature does not seem to see that."
In need of help
The Salt Lake Valley Oral Health Task Force now estimates some 70,000 low-income residents -- those who live at or below 100 percent of the federal poverty level -- have unmet dental needs. About 36 percent of the Utah population has dental disease, compared to 29 percent nationally.
Most of the patients are Hispanic or female heads of households, though the number of disabled and elderly people represented in this population is steadily growing.
