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Legislation would restore dental coverage for adults on Medicaid in Pennsylvania

A patient gets their teeth cleaned during a free dental assistance event.
Katie Blackley
90.5 WESA
A patient gets their teeth cleaned during a free dental assistance event in Pittsburgh. A state House bill would provide more dental services coverage for adults in the state's Medicaid program.

Advocates and dentists are hopeful a state House bill will restore dental services for adults with Medicaid coverage in Pennsylvania.

The legislation passed the Democratic-controlled state House last month in a bipartisan 153-50 vote. Local sponsors include former state Rep. Sara Innamorato, Rep. Emily Kinkead, a Democrat, and Republican Rep. Valerie Gaydos.

“Dental care is absolutely essential,” said Gaydos.

Reinstating the coverage will be a benefit for both patients and dentists, said Helen Hawkey, executive director of the Pennsylvania Coalition for Oral Health, which has been advocating for the change for a number of years.

Medicaid is a health insurance program that covers low-income individuals and is jointly funded by states and the federal government. More than 3.3 million people statewide are enrolled in the program, also known as Medical Assistance.

Coverage for many adult dental services was cut in 2011 under the administration of former Gov. Tom Corbett as part of a cost-saving move; the change was estimated to save about $18 million in state funds at the time. Since that time, adults in the state’s Medicaid program have had a very limited set of dental benefits that don’t cover much beyond routine exams, cleanings and basic fillings.

The program won’t routinely cover such things as root canals or crowns unless patients show they have a serious or life-threatening condition and obtain an exception. There is a lifetime limit on one set of dentures unless the patient receives an exception.

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“Oral health, I mean, it's part of overall health. If you have a dental problem and you don't take care of it, it can lead to medical problems,” said Dr. James Mancini, a local dentist who supports the legislation.

Combined with low reimbursement rates, cutting the benefits led to far fewer dentists accepting Medicaid, making it harder for patients to get care, said Dr. Mancini.

Dr. Matthew Weiss, whose practice in Bellevue accepts Medicaid, says he sees every day the need for more providers to accept Medical Assistance. He is hopeful the legislation will help.

“People have nowhere to go. And I see that firsthand because we are inundated with patients,” he said.

Weiss said the lack of full dental coverage leads to people often having their teeth pulled, rather than saved, which can impact a person’s quality of life.

“This is something certainly that should be a bipartisan effort,” Gaydos said. “It is a cost savings and it is taking care of people. It is a win-win.” She said she believes the change will ultimately save money in the long run through providing patients with better preventative care

The bill is now in the state Senate, before the Human Services Committee. There is also a similar Senate bill, sponsored by Minority Leader Sen. Jay Costa, a Democrat.

“Pennsylvania is failing its most vulnerable residents,” Costa wrote in a memo to senators seeking co-sponsors. “Cuts made in 2011 to dental coverage under our state’s Medical Assistance program prevent many low-income Pennsylvanians from receiving the oral health care they need.”

An analysis of the bill by House Democrats estimated the costs to restore the coverage would be about $155 million annually; about $40 million would come from state funds, with a $115 million federal match.

However, coverage of preventative care has long-term benefits, Hawkey said.

“If we don't pay for these benefits now, we're just going to pay something else later. The average national cost for an emergency room visit for a dental problem is $800 a pop,” she said.

Kate Giammarise focuses her reporting on poverty, social services and affordable housing. Before joining WESA, she covered those topics for the Pittsburgh Post-Gazette for nearly five years; prior to that, she spent several years in the paper’s Harrisburg bureau covering the legislature, governor and state government. She can be reached at or 412-697-2953.