It depresses LaShun Cooper to watch one of her front teeth turn a little blacker each day. It makes her feel worse to know that when the tooth goes, the partial denture next to it will probably fall out. Cooper, who’s thirty-six, hates the thought of going through life with a gap in her mouth. “It’s not supposed to matter what people think, but it’s a big part of your life,” says the single mother of three.
A few years ago, Cooper had a run of bad luck. After she was injured in a nasty fall, she lost her job and had to live on unemployment benefits. Then, in 2008, she moved from Ypsilanti to Ann Arbor. She was delighted to see her two younger children thriving in their new schools. She figured her luck had turned.
But last May, Governor Granholm issued an executive order that eliminated Medicaid payments for dental work for adults–except for emergencies, such as swelling and extreme pain, that would require an extraction. Cooper, who had qualified for Medicaid just before the order was issued, can’t afford to pay anyone to save her bad tooth. She’s still jobless while training to be an X-ray technician at Washtenaw Community College.
Almost 24,000 Washtenaw County adults depend on Medicaid. Even before Granholm cut off funding, though, it was hard to find a dentist who’d accept it. “Medicaid reimbursement doesn’t even cover the cost of opening the door and turning on the lights,” says local dentist Dalbert Fear, known for his generosity in treating needy patients. Still, Medicaid paid the bills for about 25 percent of patients at the U-M School of Dentistry and 30 percent at the downtown Community Dental Center (a nonprofit funded by U-M).
Several other money-strapped states have cut Medicaid dental payments–an easy move since the patients have no lobbying clout. Joan Doughty, the outspoken executive director of the Community Action Network, says policymakers wrongly view dental care as expendable. Without it, “you’re seeing people not being able to eat nutritious food,” she says. “Twenty-one-year-olds not being able to chew!”
Granholm proposed taxing doctor bills to raise the money to restore dental services, but that plan was killed in the state senate. At this point no one knows if or when her order will be lifted. When the state last cut dental Medicaid, in 2005, it wasn’t restored for two years. Critics complain that the amount of money saved (estimated at $5 million in 2010) is negligible–particularly since medical complications from untreated dental patients send many of them to the emergency room. In October, an Alpena woman, a disabled Medicaid recipient, died from an untreated dental infection.
Some former Medicaid patients have managed to pay their own way at either the dental school or the Community Dental Center. Ypsilanti’s Hope Clinic, typically the last resort for the destitute, is overwhelmed and no longer accepting new dental patients. Cooper and others simply go without care. “The only way I can really get work done is I have an emergency,” says Ava Bauer, a Medicaid patient with disabilities.
Locally, a handful of community activists and dentists have tried, with slight success, to help Medicaid refugees. An informal task force has “surveyed dentists and dental hygienists and assessed the state of access to oral health care in the county,” says its chair, community activist Ruth Kraut, but so far has “not taken on any major access-to-care projects.”
Kate MacEwen of Community Residence Corp., a nonprofit agency that works with adults with disabilities, has organized a monthly “Chow Down for Change” fund-raiser at various local restaurants, which donate a share of their profits to pay for dental work for her clients. (See www.communityresidence.org for schedule.) She’s also talking with Dr. Sam Zwetchkenbaum, who works at U-M Hospital’s emergency dental clinic, about placing donation jars for the needy in local dentists’ offices.
One of the most dedicated volunteers is Tammy Kraeger, a dental hygienist who works at a clinic for low-income kids at Mack School. She says parents constantly ask if she can help them. Kraeger tries to connect them with a “small but devoted group of dentists” who see patients for little or no money. She “guards the list,” she says, because those dentists would be swamped if their names were made public.
Some complain that the School of Dentistry could do more but has shown little interest in helping. “They have refused to see people in agony,” charges Doughty. Dental school administrator Stephen Stefanac says that he understands the distress but that the clinic’s “primary mission is education.”
A Lansing lawyer, Gary Gordon, has filed a class action suit on behalf of Medicaid patients demanding the state restore the dental payments. But even if the suit succeeds, it’s unlikely to come soon enough to save LaShun Cooper’s tooth. Still, she feels worse for her teenage son, who needs and desperately wants braces. Medicaid never paid for braces, but if Cooper could command a tooth fairy, she’d ask for help for her son first.