A cost-saving Pa. dental policy did the opposite, lawmakers, health advocates say

To save money, in 2011 the Pennsylvania Department of Human Services curtailed most dental services for adults covered by Medicaid. Now, lawmakers and advocates are pushing to reverse the decision, arguing that it harmed patients and increased spending elsewhere.

Millions of adults in Pennsylvania rely on Medicaid, but the program, which DHS oversees, typically doesn’t cover much beyond routine dental exams, cleanings, and fillings.

James Mancini, a dentist in rural Crawford County, says extraction is the only way to treat many of his patients’ issues — unless they can pay out of pocket.

That was the case for a woman who saw Mancini last month for a shattered front tooth. Because more advanced procedures — such as root canals and crowns — are not covered by Medicaid without an approved exception, pulling the tooth was the best and least expensive option.

“It’s a terrible choice to make,” Mancini told Spotlight PA.

In rare cases, the department allows additional services when someone has a life-threatening condition or would require more expensive care later on, a practice also known as a benefit limit exception.

“You basically have to say you’re going to die without the service and then get everyone in the world to sign off on that,” said Helen Hawkey, executive director at the Pennsylvania Coalition for Oral Health.

This process makes accessing dental care, which is already a challenge in rural areas, unachievable, Hawkey told Spotlight PA.

Mancini, who has worked in dentistry for more than two decades, said he’s filled out hundreds — if not thousands — of requests for exceptions. He recalls just one being approved.

Before the 2011 change, Medicaid in Pennsylvania covered services like root canals and emergency exams. The limitations, which were made under the Corbett administration, aimed to save an estimated $18.9 million in the state’s annual budget.

Health advocates, however, argue that the change has instead increased medical spending elsewhere as adults seek relief in emergency rooms, which bill at higher rates. They also say the restrictions lead to poor health outcomes and hurt someone’s chances of getting a job if they’re missing teeth.

“There have been these unintended consequences all leading to say that we haven’t really saved money,” Hawkey said.

The American Dental Association has said that nationwide, many emergency room visits related to dental issues could have been avoided by care at a dental office, and that patients would have paid less. Using data from a 2023 state study on rural dental health, the Pennsylvania Coalition for Oral Health estimates that these visits cost more than $35 million annually.

Democrats have proposed restoring adult Medicaid dental benefits to their pre-2011 form, at a minimum. Arguments against the move usually come down to cost.

Last year, the state House — where Democrats maintain a narrow majority — approved a bill that would restore the previous benefits, providing that state and federal match funding is available to support services.

During a state House committee meeting to vote on the proposal, Democrats estimated that expanding these adult dental benefits would cost $155 million a year. Pennsylvania would pay $40 million, and federal match dollars would cover $115 million.

Department of Human Services Secretary Val Arkoosh said the agency supports efforts to expand coverage, noting the benefits of better care.

“Not only is there a physical health component to this — a very critical one — but there’s a very simple matter of reducing job opportunities for people who don’t have good dentition,” Arkoosh told Spotlight PA.

The legislation has yet to move in the Republican-controlled state Senate.

A spokesperson for Senate GOP leadership and state Sen. Michele Brooks (R., Mercer), who chairs the Health and Human Services Committee, did not respond to requests for comment on the proposed expansion.

“We’re being penny-wise and dollar-stupid,” state Senate Minority Leader Jay Costa (D., Allegheny) told Spotlight PA.

Costa also has a bill that would restore the previous dental coverage, but urged his colleagues to prioritize the state House legislation when they return to Harrisburg later this month.

90.5 WESA partners with Spotlight PA, a collaborative, reader-funded newsroom producing accountability journalism for all of Pennsylvania. More at spotlightpa.org.