University of Kentucky dental school Dean Jeffrey Okeson (left) spoke to a legislative committee in August. He was joined by Dr. Margaret Hill (center), dean of the University of Louisville dental school and Dr. Pamela Stein, dental dean at University of Pikeville. (Photo by Deborah Yetter)

Around 400 patients per 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 a legislative committee.

Swelling from dental infection threatens patients’ airways, leaving them unable to survive an hours-long ambulance ride to Lexington from rural Kentucky, Yeoh said. 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. 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, Yeoh said.

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

Yeoh became one of the latest health professionals to speak on behalf of regulations to enhance Medicaid dental services, as well as hearing and vision care, introduced this year by Gov. Andy Beshear, a Democrat.

“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 changes have run into a wall of opposition from Republican legislators who hold a super-majority in the General Assembly and claim the governor usurped their authority over Medicaid by enacting the expansion through executive order.

Lawmakers 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 them and Beshear, who is seeking a second term as governor.

‘At home on their couch’

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

Sen. Damon Thayer, the powerful Senate Republican majority leader, complained 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 may include 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. Advocates who spoke that day described the characterization as inaccurate, saying most people covered through Medicaid who are not disabled work at low-wage jobs that don’t include health coverage.

To get better jobs, they need better health benefits, they 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 Sen. 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.”

Advocates say the newly expanded dental benefits are urgently needed. They 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 the low reimbursement rates Medicaid pays providers, causing many 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, which has held several meetings on the Medicaid benefits.

Okeson was joined by the deans of the University of Louisville dental school and a new one planned 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,” she told legislators. “Your money will never be better spent.”

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 infected, abscessed 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’

Lawmakers took no action on the regulations at the September meeting, though they could have found them “deficient,” setting them up to be voted down when the legislature next meets.

But it appears an effort to keep the benefits in place is underway.

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

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

Instead, rather than voting to disapprove the regulations expanding Medicaid benefits on Sept. 12, lawmakers transferred 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.”