PA lawmakers push to restore Medicaid dental benefits for adults • PA Spotlight

BELLEFONTE — To save money, in 2011 the Pennsylvania Department of Human Services cut most dental services for adults covered by Medicaid. Now lawmakers and advocates are pushing to overturn the decision, arguing it has harmed patients and increased spending elsewhere.

Millions of Pennsylvania adults rely on Medicaid, but the program, which DHS oversees, typically doesn’t cover much beyond routine dental exams, cleanings and fillings.

James Mancini, a dentist in rural Crawford County, says extraction is the only way to treat many of his patients’ problems — unless they can pay out of pocket.

That was the case with a woman who saw Mancini last month for a broken front tooth. Since more advanced procedures — such as root canals and crowns — are not covered by Medicaid without an approved exception, pulling the tooth was the best and least expensive option.

“It’s a terrible choice to make,” Mancini told Spotlight PA.

In rare cases, the department allows additional services when someone has a life-threatening condition or would need more expensive care later, a practice also known as a benefit limit exception.

“Basically, you have to say you’re going to die without a job and then get everyone in the world to endorse it,” said Helen Hawkey, executive director of the Pennsylvania Oral Health Coalition.

This process makes access to dental care, which is already a challenge in rural areas, unachievable, Hawkey told Spotlight PA.

Mancini, who has worked in dentistry for more than two decades, said he has filled out hundreds — if not thousands — of requests for exceptions. He remembers that only one was approved.

Before the 2011 change, Medicaid in Pennsylvania covered services like root canals and emergency exams. The cuts, which were made under the Corbett administration, were intended to save about $18.9 million in the state’s annual budget.

Health advocates, however, argue that the change has instead increased medical spending elsewhere, as adults seek help in emergency rooms, which bill at higher rates. They also say the restrictions lead to poor health outcomes and hurt someone’s chances of getting a job if they’re missing teeth.

“There were these unintended consequences, all of which led to saying we didn’t really save money,” Hawkey said.

The American Dental Association said that nationally, many emergency room visits related to dental problems could have been avoided with dental office care and that patients would have paid less. Using data from a 2023 state survey of rural dental health, the Pennsylvania Oral Health Coalition estimates that these visits cost more than $35 million annually.

Democrats have proposed restoring Medicaid dental benefits for adults to their pre-2011 form, at least. Arguments against the move usually come down to cost.

Last year, the state House — where Democrats maintain a narrow majority — approved a bill that would restore previous benefits, provided state and federal funding is available to support services.

During a state committee meeting to vote on the proposal, Democrats estimated that expanding these dental benefits to adults would cost $155 million a year. Pennsylvania would pay $40 million, and federal match dollars would cover $115 million.

Department of Human Services Secretary Val Arkoosh said the agency supports efforts to expand coverage, noting the benefits of better care.

“Not only is there a physical health component — a very critical one — but there’s a very simple matter of reducing employment opportunities for people who don’t have good dentition,” Arkoosh told Spotlight PA.

The legislation has yet to be moved in the Republican-controlled state Senate.

A spokesman for Senate GOP leadership and state Sen. Michele Brooks (R., Mercer), who chairs the Health and Human Services Committee, did not respond to requests for comment on the proposed expansion.

“We’re penny wise and dollar foolish,” state Senate Minority Leader Jay Costa (D., Allegheny) told Spotlight PA.

Costa also has a bill that would restore previous dental coverage, but urged his colleagues to prioritize the state House legislation when they return to Harrisburg later this month.

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