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KBIA’s Health & Wealth Desk covers the economy and health of rural and underserved communities in Missouri and beyond. The team produces a weekly radio segment, as well as in-depth features and regular blog posts. The reporting desk is funded by a grant from the University of Missouri, and the Missouri Foundation for Health.Contact the Health & Wealth desk.

Dental Benefits Return to Missouri Medicaid...For Now

Bram Sable-Smith
Kenneth Fanning smiles after leaving the Mission of Mercy dental clinic in August.

In January, Missouri Governor Jay Nixon announced the state would expand dental benefits to an estimated 282,000 Medicaid recipients for the Fiscal Year 2016. The expansion is being funded with money collected from a one-time tax amnesty for delinquent taxpayers.

This marks the first time dental benefits have been included in Medicaid coverage in Missouri since 2005.

“Everybody thinks of [dental coverage] as this extra add-on thing,” says Gary Harbison, executive director of the Missouri Coalition for Oral Health.

“We’ve seen this around the country where legislatures pull that benefit out [of Medicaid coverage] when they think it’s a way to save money.”

But, says Harbison, it doesn’t work out that way.

The number of patients visiting an emergency department for dental care has surged in the county, as it has here in Missouri. In 2013, for example, the Missouri Department of Health and Senior Services estimated Missourians visited emergency departments 57,641 times for dental complaints, totally $17.5 million in charges.

“Receiving regular preventive care from dentists is the most effective way to avoid [emergency department] visits for dental problems,” the report states. But by one estimate, as many as 2.4 million Missouri adults could be without dental coverage – making that preventative care challenging to obtain.

“I think the best way to get a beat on what it’s like to not have dental benefits in Missouri,” says Harbison, “is to look to the folks that go to the Mission of Mercy events.”

The Missouri Mission of Mercy is an annual charity dental clinic held in the state. KBIA visited the 2015 clinic held July 31-August 1 at the Hearnes Center in Columbia. There, more than 1,000 volunteers helped to provide 1,334 cleanings, 910 fillings and 2,286 tooth extractions to 1,723 patients. All of it free of charge.

Treating that many people in that amount of time meant a lot of waiting in line for patients.

Donnie Jacobs and Michelle Edder, for example, waited in line for more than four hours just to get inside the building. That does not included the time it took to fill out paperwork and have their actual procedures done – both believed they had cavities.

“It’s kind of discouraging seeing this long line,” Jacobs said when he first arrived at 5 a.m. the first morning of the clinic. It was still dark outside with crickets chirping and a blue moon overhead.

Without dental insurance, charity dental clinics like this one are the only options for Jacobs and Edder, so they stuck out the wait.

This is the dental coverage gap the Medicaid dental benefits are helping to close in Missouri. But there is one big caveat to the expansion: it’s only in the budget for 2016, which ends  June 30th.

When the benefits were announced, Governor Nixon estimated the program wouldn't be up and running until April. That leaves only a 3 month window of coverage.

“If there’s no money going forward, we’re kind of left dangling,” Harbison says.

“Some services could be provided during that time, but not adequate to really see a shift in people going to emergency rooms, or to take care of people’s oral health so they’re ready to go out and work and be productive citizens.”

It also might not be enough to convince more dentists to provide for Medicaid patients.

There is a silver lining, though. Dental benefits did get passed in the State’s Fiscal Year 2015 budget as well, only to be withheld by Governor Nixon due to financial constraints. Haribson is hopeful they will find their way into next year’s budget too.

A curious Columbia, Mo. native, Bram Sable-Smith has documented mbira musicians in Zimbabwe, mining protests in Chile, and the St. Louis airport's tumultuous relationship with the Chinese cargo business. His reporting from Ferguson, Mo. was part of a KBIA documentary honored by the Missouri Broadcasters Association and winner of a national Edward R. Murrow Award. He comes to KBIA most recently from the Salt Institute for Documentary Studies in Portland, Maine.
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