Legislators waive chance to set up repeal of expanded Medicaid services, and are talking with administration officials about it

University of Kentucky dental Dean Jeffrey Okeson, left, spoke to
a legislative committee in August unsupport of expanded Medicaid
dental services along with Dr. Margaret Hill center, dental dean at
the University of Louisville, and Dr. Pamela Stein, dental dean at
the University of Pikeville. (Kentucky Lantern photo by Deborah Yetter)

By Deborah Yetter

Kentucky Lantern

Around 400 patients every week, most covered by Medicaid, flood the University of Kentucky’s dental clinic seeking care they can’t find elsewhere for advanced tooth decay or other oral disease.

Some are in such critical condition they must be airlifted to UK, Dr. Melvyn Yeoh, the university’s chairman of oral-health science, recently told state legislators. Swelling from dental infection threatens some patients’ airways, leaving them unable to survive an hours-long ambulance ride to Lexington from rural Kentucky.

Others arrive with advanced oral cancers that could have been detected and treated sooner with regular dental care.“Bad teeth cause life-threatening infections,” said Yeoh, who testified Sept. 12 before a legislative committee in support of expanded Medicaid dental benefits.

“With late-stage oral cancer diagnosis, people can die,” Yeoh added, noting that Kentucky has the nation’s second highest rate of oral cancer. It ranks 49th in overall oral health.

Some patients wind up in intensive care for days or weeks, Yeoh said, and such cases run up hundreds of thousands of dollars in medical bills, often paid by Medicaid, in cases that might have been addressed earlier at far less cost in a dentist’s office.

“It’s actually driving up the costs of health care,” he said.

Yeoh was one of the latest health professionals to speak on behalf of expanded Medicaid dental services, as well as broader hearing and vision care, introduced this year by Gov. Andy Beshear.

“I am extremely excited about it,” Yeoh told the committee. “We think it can do a lot for us as providers of dentistry in Kentucky.”

But the Democratic governor's changes have run into a wall of opposition from Republican legislators who control the General Assembly and claim he usurped their authority by expanding care through executive order.

Legislators can’t take any action to override the expanded benefits until they meet in the next legislative session in January, but some continue to blast Beshear, who is seeking a second term in the Nov. 7 election.

‘At home on their couch’

An outspoken critic, Rep. Randy Bridges, R-Paducah, said at the Sept. 12 hearing that Beshear’s effort was “a loophole or political move” to avoid going through proper legislative channels.

Senate Majority Floor Leader Damon Thayer complained that Medicaid — which covers health care for some 1.6 million low-income Kentuckians, about one-third of the state’s population — has grown too large and includes enrollees simply unwilling to work.

“When I continue to see these stories about 18- to 34-year-old white men who’d rather sit at home on their couch with their Netflix remote and their DoorDash, it really aggravates me that they are living on the taxpayers’ money when they are able-bodied and should be out there working,” Thayer said.

Thayer didn’t cite any source for that claim, and Medicaid money goes to providers, not patients. Advocates who spoke that day said his characterization was inaccurate because most Medicaid beneficiaries who are not disabled work at low-wage jobs that don’t include health coverage. 

To get better jobs, they need better health benefits, which may help them get into the labor market, advocates said.

“We’re talking about workforce readiness here,” said Sheila Schuster, executive director of the Kentucky Mental Health Coalition. “If we want people to get back, as Senator Thayer has suggested, into the real workforce, the full-time workforce, we need to make sure they can see and hear and are not suffering from dental pain.”

The expanded benefits include services such as dentures, fillings, root canals, and crowns not previously covered by Medicaid, which for years covered only one annual checkup and tooth extraction for adults.

A shortage of dentists, and Medicaid's low reimbursement rates, causing many dentists to opt out of the federal-state health plan, has created an oral health crisis in Kentucky, they say. Even with the expanded benefits introduced this year, patients can’t find providers who take Medicaid.

“It’s an enormous problem that we have here and it’s not getting any better,” Dr. Jeffrey Okeson, dean of the UK dental school, told lawmakers at a hearing in August before the Administrative Regulation Review Subcommittee.

Okeson was joined by the deans of the University of Louisville dental school, and a new one in development at the University of Pikeville, in urging support for the expansion of Medicaid dental services.

One patient ‘alive today’

Meanwhile, advocates say such services are especially needed for vulnerable adults struggling to escape circumstances including domestic violence and addiction.

Ann Perkins, executive director of Safe Harbor of Northeast Kentucky, one of the state’s 15 regional domestic-violence shelters, said dental as well as vision and hearing services are essential for clients who need them to succeed in school, job training and employment.

“This is how our state can actually do something productive,” Perkins told legislators. “Your money will never be better spent.”

She said some of her clients are in dire situations, including a woman suffering from lung cancer who could not undergo chemotherapy until she got treatment for abscessed, infected gums. The client had called every dentist in the region but none who accepted Medicaid could fit her in, Perkins said.

Perkins used $500 in Safe Harbor funds to pay for the dental treatment, which the woman later repaid, she said. “She’s doing great,” Perkins said. “She’s just one example of how important dental care was for her to be alive today.”

John Bowman, Kentucky coordinator for Dream.org, a national non-profit that works for criminal-justice reform, said such benefits are “huge” for people recovering from addiction, including himself.

“It gives people a sense of self-worth,” he said. “If we want people to be productive members of society, we need to back them with these services.”

‘To us, it was a win’

Legislators took no action on the regulations expanding Medicaid benefits at the Sept. 12 meeting. They could have found them “deficient,” setting them up to be voted down when the legislature next meets. So iIt appears that an effort is uderway to keep the benefits in place.

Rep. Derek Lewis, R-London, co-chair of the committee, said discussions have begun with Beshear administration officials, following complaints by lawmakers they had not been consulted. Lewis said he and co-chair Sen. Stephen WestR-Paris, were contacted recently by Eric Friedlander, secretary of the Cabinet for Health and Family Services, and Medicaid Commissioner Lisa Lee, to discuss the issue.

“I think that goes a long way toward working this out,” Lewis said.

Rather than voting to disapprove the regulations on Sept. 12, the commitete sent them for further review to the joint Health Services Committee, which is unlikely to take them up for several months.

Yeoh, the UK dental official, said he views it as a good sign the committee didn’t reject them outright.

“To us it was a win,” he said. “We’re extremely happy about that.”