Now, while the Affordable Care Act will expand Medicaid, dental care for adults is not offered with Medicaid in every state. Pennsylvania is one of the few places that has provided it. But because of budget cuts, the state is now offering only the most basic dental coverage for adults on Medicaid. Essential Public Radio's Erika Beras has the story of one woman affected by that change.

ERIKA BERAS, BYLINE: Marcia Esters gets around in a motorized wheelchair because of a spinal disorder that got worse after a workplace accident. Last fall, she went to her dentist. He told her she needed crowns for six of her bottom teeth, and her top dentures were wearing out. And because of changes made to Medicaid in the last budget, she would now have to pay out of pocket.

MARCIA ESTERS: It's thousands of dollars that I cannot afford. I have one income, and my family is poor.

BERAS: Over the last few months, her teeth have gotten worse. She can only eat pureed food, and she's isolating herself.

ESTERS: I don't go anywhere unless I have to. You know, people look at you when you're in a wheelchair, or have to have the kind of assistance I have, anyway. But if you could look or feel halfway decent, it just helps. It really does.

BERAS: Medicaid coverage varies by state. Most states don't cover any dental care. Last year, Gov. Tom Corbett reduced dental benefits for Pennsylvania's 2 million adult Medicaid patients to just basic dental care - eliminating root canals, periodontal disease work; and limiting the number of dentures a patient can receive. The plan now only covers cleanings, fillings and extractions. The state estimates this is saving $42 million a year. Anne Bale is from Pennsylvania's Department of Public Welfare.

ANNE BALE: While we know we have a good benefit, we have to limit it, somehow and someway. We can't keep up with the spending that is going on with this dental benefit. So we are looking to limit the number of procedures that people have so we can, you know, ensure the program for the future.

BERAS: The state allows dentists to petition for additional funds if the dental condition will severely worsen a patient's chronic illness. Since last fall, the state has received more than 7,500 petitions. Most were denied, including Marcia Esters'.

Surveys show people with disabilities - with both private and public insurance - have a harder time seeing a dentist than any other demographic. That's because most dentists don't take patients on Medicaid. There are other issues as well. Patients with behavioral issues may require sedation for basic care, that only an anesthesiologist can provide. Not all dental offices are able to accommodate someone in a wheelchair.

LYNN TAICLET: This is a Hoyer lift, if somebody's - can't transfer from a wheelchair to a dental chair. You actually have, like, this...

BERAS: Lynn Taiclet runs the Center for Patients with Special Needs at the University of Pittsburgh's dental school. She says many dentists never had to learn to work with this population.

TAICLET: Patients that we see, who live in group homes and in their families' homes now, didn't do that 40 and 50 years ago. They were institutionalized at a young age. And the institutional setting took care of their medicine, their dentistry - all of it.

BERAS: Marcia Esters is hoping that a charity will help with her dental expenses. She's already struggling with digestive issues and depression, but treatment for those is covered.

For NPR News, I'm Erika Beras.


RAZ: This story was produced in collaboration with Pittsburgh's Essential Public Radio, and Kaiser Health News.


RAZ: And you're listening to ALL THINGS CONSIDERED, from NPR News.

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