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The recession may be easing slightly, but states across the country continue to face eye-popping budget deficits. States are cutting deep into public health programs and dental benefits for Medicaid recipients are at the top of the list.
In California, it's been seven months since some three million poor and disabled adults lost their dental coverage.
Sarah Varney of member station KQED reports on how dentists and their patients are responding.
SARAH VARNEY: In thousands of dentist's offices and community clinics in California, from the rocky north coast to the Mexican border, it's the receptionists who are left to counsel and console patients who've lost their benefits.
Ms. CLAUDIA RICO: They would come here crying, they need help.
VARNEY: Claudia Rico is a receptionist at Clinica de Salud Valle Salinas, a safety-net dental clinic in the central coast town of Salinas. She says more and more patients are showing up each day with swollen gums and infected teeth. Prior to the state budget cuts, Medicaid patients here could get annual exams, cleanings and, if needed, root canals in order to save their teeth.
Now, Claudia says, patients can't afford to pay for root canals themselves -even at the discounted rate of $600. So, they end up getting their teeth pulled.
Ms. RICO: They'd rather take it out because they don't have the money. It's either rent, food or dental work, and they opt for the most convenient - well, unconvenient(ph) for them - but the only thing they can do to relieve their pain.
VARNEY: In interviews with dozens of dentists and safety-net clinics around California, providers say patients are forgoing routine cleanings and delaying care until the pain is unbearable. Dentists are offering discounts and payment plans, but they say few patients can afford them. Dental schools and free clinics are overrun, and some private dental offices and at least one community dental clinic have closed.
Federal law considers dental an optional benefit that states don't have to provide when insuring poor or disabled residents. In fact, at least seven states - Virginia, Delaware, Alabama, Texas, Colorado, Utah and Missouri -provide absolutely no coverage, even for emergency relief of pain and infection. And a growing number of states have scaled back their programs and cover dental emergencies only.
Julia Paradise is a Kaiser Family Foundation health researcher.
Ms. JULIA PARADISE (Health Researcher, Kaiser Family Foundation): In the last recession and in this recession and when states are under severe budget strains, dental benefits for adults, since they are an optional benefit, are among the first things to go.
VARNEY: In California, the state will still pay to have a tooth pulled in an emergency, but it no longer covers the cost of expensive dentures. That's a big problem for seniors. Medicare doesn't cover dental, so poor seniors in California have long relied on state dental benefits when they need dentures.
Lucresha Renteria runs the Mendocino Coast Clinics in Fort Bragg, a hardscrabble fishing-and-lumber town.
Ms. LUCRESHA RENTERIA (Mendocino Coast Clinic): The nutritional needs of the patient can't be met if they can't chew and eat food appropriately. So, we have patients that suffer from a form of anorexia or have to have soft foods only.
VARNEY: The mouth has long been an orphaned organ, says Burton Edelstein, a Columbia University professor of dentistry and health policy. When Medicaid and Medicare were created in 1965, Edelstein says, oral health was not well understood, and Congress didn't think to mandate dental coverage.
Dr. BURTON EDELSTEIN (Dentistry, Health Policy, Columbia University): It reflected policymakers' misunderstanding that the mouth is not part of the body and that oral health is not an important component of general health.
VARNEY: That has largely changed. Over the last decade, federal public health agencies have aggressively promoted oral health and its connection to diabetes, stroke and heart disease. Oral health advocates say the cancellation of dental coverage for poor and disabled adults in California - and elsewhere around the country - comes just as they were gaining ground on dental disease.
But Michael Bird, from the National Conference of State Legislatures, says it will be a long time before states restore optional benefits, like dental coverage.
Mr. MICHAEL BIRD (National Conference of State Legislatures): The fiscal downturn is so severe that even if you were to raise taxes or fees you still aren't going to be able to plug all of the holes that exist right now. This is all about saving part of the school year versus the early release of prisoners versus an optional dental program versus whether you're going to be able to fill the potholes on the roads.
VARNEY: Bird says state coffers are empty and all the easy choices were made long ago.
For NPR News, I'm Sarah Varney.