Dr. Pamela Stein (right), dean of the University of Pikeville dental school, spoke in Frankfort Tuesday about the need for expanded Medicaid dental benefits, joined by Dr. Margaret Hill, interim dean of the University of Louisville dental school, and Dr. Jeffrey Okeson, dean of the University of Kentucky dental school. (Photo by Deborah Yetter)

Working at a public “safety net” dental clinic in rural Western Kentucky, Dr. Pamela Stein routinely saw a heartbreaking sight.

“It was not unusual at 6 o’clock in the morning to see 10 or 15 people standing in line waiting to get in because they had tooth aches, because they couldn’t find anyone else to care for them,” said Stein, appointed last year as dean of a new dental school being formed at the University of Pikeville.

Some patients at the Marshall County clinic were in tears after having diseased, throbbing teeth removed at the clinic operated by the University of Kentucky, she said.

“People would actually cry, they were so relieved,” Stein said, speaking before a legislative committee Tuesday in Frankfort.
She and others spoke in support of the state’s recently expanded Medicaid dental services for adults to include dentures, fillings, root canals and crowns. Medicaid previously paid only for one annual cleaning and tooth extractions for adults though children get a full range of services.

Stein joined the deans of dental schools at the universities of Kentucky and Louisville to urge continuation of the dental services authorized by Gov. Andy Beshear that have ignited a partisan political fight in Frankfort.

Republicans who control the General Assembly are seeking to block Beshear, a Democrat, from expanding Medicaid dental coverage, as well as vision and hearing benefits, arguing he usurped power that rests with lawmakers.

Officials with the Beshear administration disagree, saying they had the authority because the $39 million expansion is paid for through savings in Medicaid and doesn’t require allocation of new money. The federal government covers 85% of the costs.

But the dental school deans, as did other witnesses who appeared, avoided politics, instead focusing on Kentucky’s abysmal oral health — it ranks 49th in the nation — as well as low reimbursement rates that keep many dentists from treating Medicaid patients.

As a result, many patients living with untreated dental disease can’t find a dentist, especially in rural areas, or often find long waiting lists. And oral infection is linked to a host of other health problems that plague Kentucky, including heart disease, stroke, diabetes and premature births.

“It’s an enormous problem that we have here and it’s not getting any better,” said Dr. Jeffrey Okeson, the UK dean.?Okeson said Medicaid doesn’t cover costs of dental care.

For example, he said, UK last year billed Medicaid $14.2 million to treat 37,000 patients but was reimbursed only $4.1 million, about 30% of its costs. UK makes up the difference but can’t do so indefinitely if it begins cutting into the academic budget, he said.

His counterpart at U of L agreed, noting that together UK and U of L treat around 90,000 Medicaid dental patients a year, many of whom can’t find care elsewhere.

“These folks would probably not be able to receive dental care if it wasn’t for dental schools acting as a safety net,” said Margaret Hill, interim dean of U of L’s dental school.

“Today we are here before you, speaking on behalf of our patients and our students who would like to do the right thing, and ask that the Medicaid expansion of dental services continue and that rates of reimbursement be more reasonable,” Hill added.

Several witnesses described the enormous suffering of patients who previously lacked dental coverage and now, even if covered under the expanded benefits, can’t find a dentist.

“I don’t mean to tug on your heart strings but I really hope that I do,” said Tiffani Hays, a social worker who works with cancer patients in Winchester, many in dire need of dental treatment. “Oral health is probably one of the most common problems in our patients.”

It was the first opportunity for public comment on the dental benefits expansion enacted by Beshear in April after the lawmakers voted down his first, Jan. 1 expansion in the 2023 legislative session. Beshear reinstated them, with some changes, after lawmakers adjourned.

The stop and start nature of the expanded benefits has patients scared, said Missy Newland, a Louisville woman who gets health coverage through Medicaid and needs ongoing dental care.

“The political tug of war has always had me worried about staying eligible,” said Newland, who works cleaning homes and testified by video. “I fear my access to health care will be taken away and with my health issues, that’s scary.”

The current benefits — which also include expanded benefits for items such as eyeglasses and hearing aids — are good through the end of the year. While Republican lawmakers have objected, they don’t have the power to block them till they meet in 2024 in the next legislative session.

Meanwhile, tens of thousands of Kentuckians have received benefits such as dentures, crowns, fillings, hearing aids and eyeglasses, said Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of health advocacy groups.

“These services are life-changing for people,” said Beauregard, adding that with better vision, hearing and teeth, people are more likely to find jobs.

But GOP legislators object even as some acknowledge the benefits are sorely needed for the about 900,000 adults who get health coverage from Medicaid, a federal-state health plan for low income and disabled individuals.

Rep. Randy Bridges, R-Paducah, and a vocal critic of Beshear’s expanded Medicaid services, accused officials with the Cabinet for Health and Family Services of making “end runs” around lawmakers who, he argued, hold the sole power to fund such programs through its budget committee.

“To come in here and pull at our heartstrings, to say we are the keepers of the purse — we aren’t the keeper of the purse,” he said of the Administrative Regulation Review Subcommittee holding Tuesday’s hearing.

“You’re doing end runs and you want to make us appear to be the villains and we’re not,” Bridges added. “We just want to do it in the proper manner.”

But Sen. David Yates, a Louisville Democrat, argued it’s the health needs of constituents rather than legislative procedure that should matter.

“It did in fact pull on my heartstrings as it should any Kentuckians,” Yates said. “Forget the partisan politics and political games, I think everyone agrees that something has to be done.”

Bridges also complained that witnesses who appeared in support of the expanded benefits were misled by state officials about the legislative process.

“I feel like you have inappropriately led them with some wrong ideas on how this works,” Bridges said.

That prompted a heated retort from Lisa Lee, state Medicaid commissioner, who also spoke Tuesday.

“I have never, ever misled anyone in my 23 years in Medicaid and I will not do so,” Lee told Bridges. “And I really don’t appreciate the fact that you indicated that we have been misleading people.”

As for the witnesses who spoke, Lee said, “They are here because they are concerned that people are going to lose their benefits.”

They included Dr. Bill Collins, a dentist at the Red Bird Mission dental clinic in Clay County who said he constantly seeks grants to cover the costs of dental care for patients Medicaid doesn’t fully cover.

Kentucky has one of the highest rates in the nation of adults with no teeth and patients are flocking to get dentures newly covered under the expanded Medicaid rates, Collins said.

But Medicaid covers only about half the costs, he said.

“When the grant money runs out it has to stop,” he said.

Collins was among witnesses urging lawmakers to continue expanded services and increase payments to dentists.
“You can make it a reality,” he said. “That’s what I beg you to do.”

The committee took no action Tuesday. It already has found the regulations Beshear issued to enact the expansion “deficient,” meaning lawmakers could strike them down when they meet next year.

But Rep. Derek Lewis, R-London, committee co-chair, ended the meeting on a conciliatory note, saying he’s willing to work with everyone involved to find a solution.

“I know we’re in an election year,” Lewis said, alluding to the fact Beshear is seeking a second term as governor. “What I don’t want to see is this made to be a political football, I don’t want to poison the well and leave patients and providers holding the bag.”

“I think we can make a difference,” he said. “We need to make a difference.”