ENFIELD — For the people with developmental disabilities who are under the care of Visions for Creative Housing Solutions, a routine dental appointment can clean out their modest savings accounts.
The nonprofit serves 11 residents at its Enfield location and soon will serve 11 more in Lebanon when a second location on Green Street opens later this month.
As adults with disabilities, Visions residents primarily rely on Medicaid to cover the cost of their health care needs. But New Hampshire is among a minority of states without a Medicaid dental benefit for adults.
“It’s really sad that it’s the people who are most vulnerable that really get caught in this bind,” said Sylvia Dow, Visions’ director.
Despite the state Legislature passing language in 2019 that would require health care plans serving the state’s roughly 80,000 adult Medicaid recipients to cover some dental costs, lawmakers have yet to provide funding to support the program.
The two-year $13.5 billion state budget that New Hampshire Gov. Chris Sununu, a Republican, signed into law last month does not include funding for the dental benefit, which leaves many residents to continue without coverage for preventive or restorative oral health care.
Often, the only option for these patients is to have a problem tooth pulled.
“It’s just so shortsighted,” said state Rep. Sharon Nordgren, D-Hanover. “These people end up in the emergency room having to have teeth extracted.”
Though the benefit — which would have amounted to a maximum of $1,500 per patient annually — was included in an initial version of the budget passed by the Senate, it was later eliminated by a budget conference committee, said Nordgren, who co-sponsored a Medicaid dental benefit bill in the Senate, SB 150.
As proposed, the benefit would have started in 2023 and cost the state $1.5 million for the first six months of the program, said Dr. Sarah Finne, Medicaid dental director for the New Hampshire Department of Health and Human Services. It would have covered preventive exams; restorative treatment; surgery to relieve pain, eliminate infection or prevent imminent tooth loss; and removable prosthodontics to replace missing teeth when necessary. The program also would have included transportation to appointments, as well as care management.
Some House Republicans weren’t convinced that the Medicaid dental proposal had been fully fleshed out, said Rep. Ken Weyler, R-Kingston, who serves as chairman of the House fiscal and finance committees, as well as the budget conference committee.
Weyler said he thought the program as proposed for $1.5 million for the first six months was “very unrealistic.” He said he was concerned that funding it at that level would put the state on the hook for a much larger price tag.
“Everybody’s going to be looking for the free dentures,” he said.
Should there be cost overruns, “in this current budget, you’d have to start cutting other programs,” he said.
For a full year of the program, the state would have been on the hook for about $7.45 million, with the federal government making up the remainder of the $20.32 million total cost, Finne said.
The program also would be expected to cut overall Medicaid costs by reducing emergency department visits for tooth pain and helping to improve people’s overall health by reducing pain and improving nutrition, but those savings won’t be realized all at once, Finne said.
“This is going to go on for a long time,” she said.
At least 34 other states, including Vermont, already offer Medicaid dental benefits for adults.
Red Logan Dental Clinic, a free clinic in White River Junction, treats adults without dental insurance, including those enrolled with New Hampshire Medicaid, which only covers extractions when necessary, said Dana Michalovic, the executive director of Red Logan and the related Good Neighbor Health Clinic.
In contrast, Red Logan, which hired its first full-time dentist earlier this year, does not treat those with Vermont Medicaid, which provides about $1,000 annually for dental care.
Michalovic said she’d “like to see an even playing field between New Hampshire and Vermont.”
The Mascoma Community Health Center in Canaan, which provides dental care on a sliding fee scale to people in its five-town service area, would have seen about $40,000 in additional reimbursement for dental care for patients with Medicaid had the proposal survived the budget process, said Peter Thurber, the nonprofit’s board chairman.
The nonprofit, which has an operating budget of about $1.6 million and has faced some financial difficulties amid the COVID-19 pandemic, will “have to make that up” through fundraising or other sources, Thurber said.
Though Thurber said his organization wasn’t relying on the state to fund the Medicaid benefit this year, he is optimistic it will eventually be funded.
“I hope they find some solutions,” he said.
Also not losing hope are members of the New Hampshire Dental Society.
Dr. Kristine Blackwelder, a dentist in the Lakes Region and chairwoman of the society’s Dental Medicaid Advisory Committee, said she is encouraged by the fact that more people seem to understand the connection between oral health and overall health, pointing to bipartisan support of the Medicaid dental benefit in the state Senate.
She said there’s growing awareness that poor oral health can affect people’s ability to get a job, cause them pain and prevent them from getting proper nutrition.
“The funding, I really feel confident, will come,” Blackwelder said. “We’ll just keep working at it.”
In the meantime, one of the three companies offering Medicaid plans in New Hampshire, AmeriHealth Caritas, voluntarily includes some dental coverage for adults at no cost to the state. Benefits include one cleaning a year, as well as some exams and X-rays, fillings and deep cleaning.
Finne, the state’s Medicaid dental director, said that coverage is helpful for those who simply need preventive work, but because it does not include restoration, it won’t help those who have lost teeth.
“Folks now (have) not had any preventative services for a long time,” Finne said. “Normal, routine-type of cleaning is not going to be enough.”
Nora Doyle-Burr can be reached at firstname.lastname@example.org or 603-727-3213.