More low-income Mainers will have access to dental care if the Legislature passes a proposal by a Democratic lawmaker to add an adult dental benefit to Medicaid.

Rep. Drew Gattine is proposing Medicaid dental coverage for low-income adults in Maine, saying, “Mainers realize that good dental care is part of overall health care.”

Rep. Drew Gattine of Westbrook, co-chair of the Appropriations Committee, has introduced a bill that would add a “comprehensive” dental benefit for adults who receive MaineCare, the state’s version of Medicaid. Although the bill is still being written, Gattine said the proposal would include coverage for cleanings, screenings, diagnostic care and filling cavities.

“Mainers realize that good dental care is part of overall health care,” Gattine said.

About 260,000 Mainers, including more than 100,000 adults, are enrolled in Medicaid. The program now offers dental benefits for children, but the federal government does not require states to provide a dental benefit for adults. In Maine, adults on Medicaid are now covered only for emergency dental care.

A former head of the Maine Dental Association praised Gattine’s bill but said reimbursement rates would have to be reasonable so that dentists will accept more Medicaid patients, and the state must implement the benefit carefully to avoid overwhelming dental practices with new patients, especially in rural areas.

Gattine said the cost of the proposed benefit has yet to be determined, but the state will be avoiding costs from people who end up in the emergency room with tooth pain or have other health problems because of poor oral health.

For instance, bacterial infections from untreated teeth can cause a number of health problems.

“At the end of the day, this is going to be very cost-effective,” Gattine said.

MILLS OPEN TO OPTION

In a state-by-state study in 2016, the American Dental Association estimated that Maine taxpayers’ share of the cost of an adult dental benefit under Medicaid would be between $7 million and $19 million annually, depending on utilization rates and what’s covered. Medicaid is funded with a combination of federal and state dollars, and the state’s share of Medicaid spending in 2017 was $952.5 million, according to the Kaiser Family Foundation.

Depending on the adult Medicaid population served, the federal government would pay for about 67 percent to 90 percent of the cost of each dental visit, similar to the cost sharing for medical benefits.

If the bill passes, Maine will join 33 states plus the District of Columbia in offering an adult Medicaid dental benefit.

Democratic Gov. Janet Mills did not specifically endorse Gattine’s bill, but signaled that she would be willing to expand Medicaid’s dental coverage.

“Gov. Mills believes that Maine can do a better job of ensuring access to proper dental care for all families, which is a contributing factor to a person’s overall health and their ability to work or get a job,” said Scott Ogden, Mills’ spokesman. “She would support efforts to expand dental care in a financially responsible way and will carefully consider all legislative proposals to do so.”

Gattine said an adult dental benefit under Medicaid has been a priority of his for years, but during the administration of former Gov. Paul LePage, a Republican, there was not enough political support to advance a bill.

Mainers who earn up to 138 percent of the federal poverty level – $34,638 for a family of four – are eligible for Medicaid and would be covered for dental care if Gattine’s bill passed.

POTENTIAL DELUGE OF PATIENTS

Dr. Jonathan Shenkin, past president of the Maine Dental Association, and a pediatric dentist in Augusta, said he’s optimistic about the prospects, but cautions that implementation has to be done correctly or there will be a deluge of patients and not enough access. Shenkin said reimbursement rates will have to be fair, or dentists may not accept or greatly limit the number of Medicaid patients they will be willing to see.

“There’s going to be an immense need initially,” Shenkin said. “People have been putting off their dental care for years and years and then all of the sudden there’s going to be a comprehensive benefit.”

The reimbursement rate for pediatric dental work in Maine is 44.6 percent of what a commercial plan would pay, compared with the national average of 49.4 percent. Shenkin said the pediatric rate needs to be improved, in addition to a reasonable adult rate, for people to be able to have access to dental care.

Shenkin appreciates the Legislature’s effort to address a long-neglected part of the health care system.

“It’s the right thing to do,” he said.

‘A LONG TIME COMING IN MAINE’

A 2010 study by the University of Southern Maine, which has not been updated, cited preventable dental pain as a major driver in preventable emergency room utilization.

Chris Hastedt, senior policy adviser for Maine Equal Justice Partners, an Augusta-based think tank, said low-income adults in Maine are essentially shut out of dental care, and there’s increasing awareness that dental care needs to be integrated into the overall health care system.

“This has been a long time coming in Maine,” he said.

Maine also has historically experienced a dentist shortage, especially in rural Maine. The state’s rate was 50 dentists per 100,000 people in 2017 – well below the national average of 61 dentists per 100,000, according to America’s Health Rankings, a study conducted by a private foundation that compares states on a number of health issues.

The University of New England is working to alleviate the shortage with its relatively new dental school. The dental school graduated its first class in 2017. In the 2018 class, 18 of the 63 graduates stayed in Maine.

Joe Lawlor can be contacted at 791-6376 or at:

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