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Missouri Moves to Cut Off Most Medicaid Dental Care

January 22, 1992

ST. LOUIS (AP) _ Seven years ago, Robert Nemnich’s gums grew over his teeth and he had to have surgery. Now, the state of Missouri wants to stop paying for the routine dental care that could keep that from happening again.

″Oh, I remember all the pain he was in and how he screamed all night. It was terrible. I never want to go through that again,″ recalled his mother, Marie Nemnich.

To save money, Republican Gov. John Ashcroft has ordered that Medicaid stop paying for routine dental care for the poor and disabled. A legal aid group sued, and a federal judge last week blocked the cuts until a trial, which could take months.

Robert Nemnich, 27, who has cerebral palsy and is on Medicaid, is among the 48,000 patients who could lose services.

The anti-seizure medicine he takes causes his gums to grow. Since the surgery, Nemnich has gone to the dentist several times a year to have his gums trimmed. But this preventative care would no longer be covered by Medicaid.

Ashcroft’s plan would save about $5.6 million - $2.2 million in state money and $3.4 in federal funds. The federal government gives states some leeway in which services to offer.

The situation in Missouri may become common across the country as more and more states face budget cutbacks.

″Medicaid cuts have always been an issue, but now the cuts are running much deeper. It’s coming to a crisis point,″ said Peter Morris, a lawyer with the Los Angeles-based National Health Law Program, a support center for lawyers who work with the poor and disabled.

A majority of legislative leaders in a National Conference of State Legislatures’ survey in December said they will not try to raise taxes this year to balance budgets, but will pursue cutbacks, particularly for local governments, Medicaid and welfare.

″Balancing the budgets on the backs of poor people - I think that’s definitely what’s going on and it’s probably only going to get worse,″ said Ann Lever, a lawyer for Legal Services of Eastern Missouri. She filed the lawsuit challenging Ashcroft’s order.

Sheldon Cohen, chief of dentistry at Jewish Hospital in St. Louis, said the cuts ″would be a large step backward and actually would be promoting decay and promoting emergency-type care and big problems for these people.″

Medicaid patients represent about 20 percent of the hospital’s dental practice, he said.

Most dentists recommend checkups twice a year, but under Ashcroft’s plan Medicaid would stop paying for non-emergency care, including examinations, cleanings, X-rays and most fillings, dentures, crowns and bridges.

The cutbacks would last only a year, said Donna Checkitt, director of the state’s Division of Medical Services. ″This was done purely for cost savings. No one has defended it as anything but that,″ she said.

She said Medicaid costs account for 16 percent of the state’s budget; the program costs state taxpayers $1.3 billion a year.

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