Legislators try for dental benefits again, this time with settlement money

Concord Monitor
Published: 2/20/2022 11:00:00 PM
Modified: 2/20/2022 10:59:40 PM

CONCORD — After several failed attempts at expanding Medicaid dental benefits, legislators are turning to unconventional funding sources to push the plan through.

Sen. Cindy Rosenwald, the primary sponsor of a bill aimed at providing dental benefits to Medicaid recipients, said the first couple of years of the program would be funded by a $21 million settlement the state recently reached with Centene, a Medicaid managed care organization, over prescription drug pricing.

Currently, New Hampshire is one of 10 states that offers only emergency dental coverage. Sarah Finne, the Medicaid Dental Director for the N.H. Department of Health, said that means while the plan covers the cost of tooth extractions, it does not pay for the care that could have prevented the need for extractions in the first place.

“We’re keeping people from having really serious infection but we’re not really getting at how did they end up at that point where they needed to have those extractions,” she said.

Disabled, low-income and senior Granite Staters who qualify for Medicaid must either pay out-of-pocket for preventative care, like teeth cleanings, or forgo the care altogether.

SB 422, the bill Rosenwald, a Democrat, proposed this legislative session, would expand Medicaid coverage to many dental care procedures, such as X-rays, dentures, imaging and even smoking cessation counseling.

This isn’t the first time the New Hampshire Legislature — or even Rosenwald — have attempted to build out dental benefits.

In 2020, a bill establishing dental benefits under the Medicaid program was vetoed by Gov. Chris Sununu. Although Sununu said he supported the legislation’s sentiment, he said the $11 million price tag along with “historic revenue shortfalls” during the first year of the pandemic made the program untenable. The next year, a similar bill passed unanimously through the Senate twice but died in the House due to disagreements about the cost.

“I am pushing a boulder up a very steep mountain,” Finne said.

The cost associated with the plan has been the main point of contention in debates over dental benefits. The Department of Health estimates that the dental benefits outlined in a similar piece of legislation would cost the state about $6.91 million a year.

Rosenwald is hopeful that the new source of funding will help allay some concerns. Finne said the strategy is creative but she isn’t sure whether Centene settlement money has already been spoken for.

“I have a sneaking suspicion that you’re going to have other people who have their eye on those funds,” she said.

The other barrier to establishing dental benefits is a more fundamental misunderstanding of the importance of dental care to overall health, Finne said.

“For so long, we’ve been able to just sort of cut the mouth out of the body and pretend that it wasn’t attached to everything else,” she said.

Another bill from the House, which would establish similar dental benefits through general funds has garnered bipartisan support, suggesting that the public may be appreciating the importance of dental health. Michael Auerbach, executive director of New Hampshire Dental Society, said House support for this bill is a promising indication that this year’s legislation will be successful.

“The House is a much more conservative body than the Senate,” he said. “That’s always been the toughest nut to crack but this time. We have a bipartisan group of legislators who overwhelmingly voted for a comprehensive piece.”

In New England, New Hampshire is the sole state that covers only emergency procedures under their Medicaid dental plan. Massachusetts, Rhode Island and Connecticut all have “extensive” dental benefits, according to the Center for Health Strategies. Maine recently upgraded its emergency dental program for full dental benefits in their state budget.

Auerbach said the Medicaid-eligible population has grown during the pandemic and as a result, he expects the number of adults with advanced oral disease to grow.

“If it’s carefully crafted, this will help New Hampshire residents keep down emergency room costs and enhancing health care coordination,” he said. “This is a small investment that will go a long way to helping the residents.”

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