'I want to have my teeth': Bevin's Medicaid cuts leave Kentuckians in pain

Deborah Yetter | Courier Journal

Show Caption Hide Caption 'It's just wrong:' Susan Wells talks about how Medicaid cuts affected her Wells was one of nearly 400,000 Kentuckians enrolled in Medicaid who lost their dental benefits after Gov. Matt Bevin made cuts.

After years of pain from tooth decay and infection, Susan Wells was nearly done with treatment — having most of her teeth extracted so she could get dentures.

But Wells still had five teeth left to pull when the administration of Gov. Matt Bevin abruptly cut dental benefits for her and nearly 400,000 other Kentuckians enrolled in Medicaid, leaving them with no coverage as of July 1.

"When that came up, I said 'I might as well die,'" said Wells, 51, of Louisville. "I cried. I was so angry."

Wells got the care she needed on July 11 through Shawnee Christian Healthcare Center, a nonprofit clinic in West Louisville that has decided, for now, to continue to treat its Medicaid dental patients regardless of whether they can pay.

"We're not going to abandon them the way Medicaid has," said Jennifer Hasch, the clinic's manager of dental services.

But other patients throughout Kentucky, some in urgent need of care for acute and even life-threatening infection, haven't fared so well after losing dental coverage from the government health plan for low-income and disabled individuals.

Dentists in private practice say they have been forced to turn away hundreds of patients, most of whom showed up for appointments after July 1 with no idea their Medicaid dental benefits had been eliminated. That included many who had waited months for relief from decayed teeth and abscessed gums, some in need of what dentists call "full mouth extractions."

Kentucky dentists say the Medicaid dental cuts could be catastrophic in a state with high poverty and some of the nation's worst oral health, especially in Eastern Kentucky.

"This is a big problem," said Dr. Chad Street, a Pikeville oral surgeon who's had patients wind up in intensive care from dental infection that spread through their bodies. "Patients are going to be in pain. Patients are going to end up in the hospital or in the worst case scenario, die from infection."

He said that since July 1, his office has canceled appointments for more than 200 patients who lost Medicaid coverage, some of whom had waited months to see Street, one of the few oral surgeons in Eastern Kentucky to accept Medicaid.

Street and other dentists say they hope to reschedule appointments if patients get dental coverage restored, which is uncertain.

Some of Street's patients who lost coverage were scheduled for surgery in a hospital operating room under anesthesia because a disease is so far advanced or they have health conditions that make it too risky to remove the teeth in a dentist's office.

Among them is Sandra Hayden, of Prestonsburg, who had been scheduled to have all of her teeth removed at the hospital after suffering for months with severe decay. Hayden said she is in constant pain, can barely eat and won't smile.

"This is very painful," she said. "I wanted those teeth out."

Floyd County dentist Denver Tackett said he's had patients break down after he informed them they no longer have dental coverage, including one man pleading for relief from infected teeth and gums.

"You could see him start to well up with tears in his eyes," Tackett said. "It's a sad situation."

And the problems aren't isolated to Eastern Kentucky.

In Western Kentucky, Dr. Brandon Taylor, director of Community Dental Health Clinic in Owensboro, said the clinic sees almost all Medicaid patients, many with serious decay who can't otherwise afford care. Many lost dental coverage on July 1, he said.

"People become very desperate," Taylor said. "It's not unusual for us to hear, 'I grabbed a pair of pliers out of the toolbox and tried to take my own tooth out."

State officials cut vision, dental and non-emergency transportation benefits over the weekend of June 30-July 1, catching patients and health care providers by surprise. While health advocates say all those benefits are important, untreated dental decay and infection is one of the state's most urgent health care needs.

"Peoples' lives are depending on it," said Dr. Bill Collins, an Eastern Kentucky dentist who sees patients in Clay and Pike counties.

State Medicaid officials initially said 460,000 people were affected by the cuts but on Wednesday told a legislative committee the changes left around 373,000 people with no routine dental or vision coverage.

The cuts are aimed mostly at "able-bodied" adults among the about 500,000 people added through the state's Medicaid expansion under the federal Affordable Care Act. The expansion allowed states to offer Medicaid coverage to more low-income adults starting in 2014.

Opinion: Kentucky must provide stability in our Medicaid program

Medicaid covers 1.4 million people in Kentucky, about 600,000 of them children.

Dental and vision benefits for adults are optional under Medicaid, meaning states can choose whether to offer them. Most offer some dental services for adults.

Only two states, Delaware and North Dakota, do not provide any dental services to adults added under the Medicaid expansion.

In a July 1 statement, Bevin administration officials cited a June 29 federal court ruling striking down Bevin's effort to overhaul the Medicaid health plan for able-bodied adults as a reason for the cuts. The plan included work requirements, premiums and "lock-outs" of coverage for those who don't follow the rules.

Bevin's plan, which was to take effect July 1, would have eliminated dental and vision benefits for most of those adults, but would have allowed people to earn points toward purchasing such services in a "My Rewards" account through activities such as volunteer work or on-line classes. Some people already had begun accumulating points in those accounts, which are now suspended following the court ruling.

The Cabinet for Health and Family Services said in the July 1 statement that immediate cuts in dental, vision and transportation benefits were required "to compensate for the increasing costs of expanded Medicaid" and were "an unfortunate consequence of the judge's ruling."

Health law advocates and an outside expert say the June 29 ruling by U.S. District Judge James E. Boasberg of Washington D.C. does not require any such cuts.

"There is nothing stopping the state from continuing to offer dental and vision as they had done," said Marybeth Musumeci, a lawyer and Medicaid expert with the Kaiser Family Foundation, a non-profit health policy organization.

Advocates also estimate any savings would be minimal, less than 1 percent of the state's $11 billion annual Medicaid budget, about 80 percent of that from federal money.

Challenges: Health law advocates ask US officials to reject Bevin's Medicaid cuts

Adam Meier, secretary of the cabinet, told the legislative Medicaid Oversight and Advisory Committee Wednesday that he couldn't say how much would be saved by the cuts and would have to get back to the committee.

Critics say any savings will be dwarfed by increased costs to Medicaid of emergency room visits and hospitalization of people seeking relief from infected teeth and gums.

Kentucky Dental Association President Ansley Depp, in an opinion piece released Friday, related the experience of California, which ended dental benefits for adults in 2009 to save money only to reinstate them in 2013 amid a surge in emergency room bills.

Medicaid spending for California patients seeking help for dental pain in emergency rooms rose by more than $1 million per year after the state eliminated dental coverage for adults, according to a study from the University of Iowa College of Dentistry.

Kentucky dentists say that without dental coverage, acute problems will send many more people to hospital emergency rooms, at greater cost to Medicaid. They also worry people with dental pain will wind up with narcotic painkillers when the state already is the grip of an opioid addiction crisis.

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"The local emergency rooms, urgent care centers, are going to get bombarded," said Street, the oral surgeon. "They're going to give them a prescription for an antibiotic and a pain pill and tell them to go see a dentist."

Here are some Kentuckians affected by the elimination of dental benefits:

'Thin the herd'

Susan Wells, a licensed practical nurse, said she worked for years in nursing homes as a contract employee with no health insurance. Since she couldn't afford care, she tried to ignore worsening dental problems.

"For years, I had pain all the time," she said.

After Kentucky expanded Medicaid in 2014, Wells signed up.

By the time she got dental treatment, the decay was so advanced that her only option was to have most teeth extracted and obtain dentures.

Wells was nearly done when the dental cuts were announced, cuts she attributes to a lack of understanding or compassion from the Bevin administration.

Wells said officials just want to "thin the herd."

"They want us all dead," she said. "They just don't care. They want us to go away."

Wells got her last five teeth pulled July 11 at the Shawnee clinic.

Dentists: Kids wrongly denied care under Bevin's Medicaid cuts

Hasch, the dental services manager, said the non-profit clinic has decided to keep treating Medicaid patients who lost dental coverage through this month and then assess whether to start charging a fee based on income.

Wells said she isn't currently working while she recuperatest but plans to work as an Uber driver and take part-time jobs as a home health aide. She said she's offended by Bevin's comments that his Medicaid overhaul is aimed at getting people back to work and restoring their "dignity."

"Who does he think's not working?" she said. "The dignity of work is just to rationalize doing this to people."

'Get my teeth out'

Sandra Hayden, 42, said she was about to get care for her badly decayed teeth from Dr. Chad Street, of Pikeville, who had scheduled her for surgery Aug. 8.

"Everything was fine," she said. "I thought, I'm going to be able to get my teeth out now."

Then Street's office told her she'd lost coverage because of the Medicaid cuts, ending her dreams of relief from constant pain and getting dentures to replace decayed teeth.

"It's not good for people that don't have the income, like me," she said. "I can't pay for that. I don't know what to do now."

Opinion: Transparency and public input are key protections in Medicaid changes

Hayden said she used to work at a local hospital but had to quit after she was diagnosed with multiple sclerosis. Her husband once had a good job as a coal truck driver but lost that when the coal industry began to decline and he now gets only part-time work, she said.

Hayden said she hopes eventually to qualify for government disability coverage, which would include health benefits. But she sees no immediate solution for her dental problems.

"We can always hope," she said.

'It saved my life'

Krista Seymour, 49, of Louisville, works as a freelancer for production crews that film and televise college sports. She's self-employed, which means she gets no employer health coverage.

Seymour was delighted to learn in 2014 she qualified for health care under the Medicaid expansion, more so when she later was diagnosed with thyroid cancer.

"It saved my life," she said of the Medicaid coverage that paid for her surgery, medication and ongoing treatment.

A key benefit is dental coverage, she said, because the cancer treatment left her teeth weakened and damaged. She gets care through a dental clinic at the University of Kentucky, where she also gets cancer treatment.

Seymour said she had to cancel an appointment with the UK dentist last week because her dental coverage had been eliminated. The clinic called and said she could keep the appointment, but would have to pay cash Seymour said she doesn't have.

"It hurts, it makes me feel like I'm not valued," said Seymour, who broke into tears recounting her story. "This appointment was really important to me."

The vision benefit cuts also worried Seymour, who requires regular check-ups for any signs of cancer detectable through an eye exam.

By the end of last, Seymour had some good news. After hours on the phone with state Medicaid officials, she learned they had decided to restore her benefits because of her status as a cancer patient.

Related: Yarmuth demands answers from feds on Bevin's abrupt cuts to Medicaid

She was able to reschedule her appointment after the UK dental clinic confirmed her dental coverage was restored, Seymour said.

But with the administration's plans to restructure Medicaid, Seymour said she's not taking anything for granted and expects future changes to her coverage.

"I had to fight for it," she said. "It's just one battle in this war."

And Seymour said she resents the implication in Bevin's proposed overhaul that people enrolled in Medicaid need to be motivated to work.

"There's never been a year I haven't paid taxes in this state," she said.

'Working two jobs'

Kimberly Henderson, 35, of Louisville, woke up last week in pain with her face swollen, and realized she had an abscess from an infected tooth.

So Henderson, who works two jobs, one with a janitorial service, assumed her Medicaid coverage would pay for treatment. She went to one dental clinic, then another. Both turned her down, telling her she no longer had dental benefits, Henderson said.

The news was a shock to Henderson, who said she had no idea the Bevin administration had cut her coverage.

"When you have an abscessed tooth and you need to go to the dentist, it's kind of crazy," Henderson said. "I don't have any assistance. I have to pay bills out of my own pocket."

Henderson, who wears glasses, said she also worries what she will do when if she needs new ones. Medicaid doesn't pay for glasses but does cover the cost of an annual eye exam she needs for a prescription.

"You can't get glasses if you don't have vision (benefits)," Henderson said.

Henderson was able to get treatment last week for her abscessed tooth at Shawnee Christian Healthcare, a non-profit clinic which, for now, is seeing Medicaid dental patients regardless of their ability to pay.

But Henderson said she worries about another cavity or abscess.

"I try to take care of my teeth," she said. "I want to have my teeth."

'I'm definitely afraid.'

Tavina Hensley recently graduated from Western Kentucky University with a bachelor's degree in psychology and, with classes over, was planning to schedule a dental checkup. Classwork, a part-time job and multiple medical visits for a congenital back problem left her too busy to get to the dentist sooner, she said.

But Hensley, 27, learned this month she was among those who lost their Medicaid dental benefits.

"I can't go now," said Hensley, who enrolled in Medicaid while in college. "I don't even know where to start to find coverage I can afford."

Hensley works as a supervisor at a call center but said she can't afford the health insurance the company offers employees.

Meanwhile, she's had past dental problems that already have cost her one tooth and she's worried she may have more.

"Maybe the state doesn't find dental and vision to be important," Hensley said. "Once you get an abscessed tooth, it can kill you. I'm definitely afraid right now."

Deborah Yetter: 502-582-4228; dyetter@courierjournal.com; Twitter: @d_yetter. Support strong local journalism by subscribing today: courier-journal.com/deborahy.