A cost-saving dental policy in Pennsylvania didn’t save money, lawmakers say

To save money, the Pennsylvania Department of Human Services in 2011 restricted most adult dental services covered by Medicaid. Now, lawmakers and human rights advocates are pushing to reverse the decision, arguing that it harmed patients and increased spending elsewhere.

Millions of adults in Pennsylvania rely on Medicaid, but the program, which is overseen by DHS, typically doesn’t cover much beyond routine dental exams, cleanings and fillings.

James Mancini, a dentist in rural Crawford County, says extraction is the only way to treat many of his patients’ problems unless they can pay for it out of pocket.

That was the case for a woman who came to Mancini last month for a broken tooth. Because more advanced procedures (such as root canals and crowns) aren’t covered by Medicaid without an approved exception, removing the tooth was the best and least expensive option.

“It’s a terrible choice,” Mancini told Spotlight PA.

In rare cases, the department allows additional services when someone has a life-threatening condition or would require more expensive care later, a practice also known as a benefit cap exception.

“You basically have to say you’re going to die without it and then get everyone to approve it,” said Helen Hawkey, executive director of the Pennsylvania Coalition for Oral Health.

This process makes access to dental care, already a challenge in rural areas, unattainable, Hawkey told Spotlight PA.

Mancini, who has worked in dentistry for more than two decades, said he has completed hundreds, if not thousands, of requests for exceptions. He recalls that only one was approved.

Before the 2011 change, Medicaid in Pennsylvania covered services such as root canals and emergency exams. The limitations, which were introduced during the Corbett administration, were intended to save about $18.9 million in the state’s annual budget.

But health advocates say the change has increased medical spending elsewhere, as adults seek help at emergency rooms, which charge higher fees. They also say the restrictions lead to poor health outcomes and hurt their chances of getting a job if they are missing teeth.

“There have been unintended consequences that lead us to say that we haven’t really saved any money,” Hawkey said.

The American Dental Association has said that nationwide, many dental-related emergency room visits could have been avoided if they had been treated in a dental office, and that patients would have paid less. Using data from a 2023 statewide study on rural dental health, the Pennsylvania Coalition for Oral Health estimates that these visits cost more than $35 million a year.

Democrats have proposed restoring adult Medicaid dental benefits to, at a minimum, their pre-2011 form. Arguments against the measure often boil down to costs.

Last year, the state House, where Democrats hold a narrow majority, passed a bill that would restore the previous benefits, provided state and federal funding is available to support services.

During a state House committee meeting to vote on the proposal, Democrats estimated that expanding these adult dental benefits would cost $155 million a year. Pennsylvania would pay $40 million and federal funds would provide $115 million.

Department of Human Services Secretary Val Arkoosh said the agency supports efforts to expand coverage, highlighting the benefits of better care.

“Not only is there a physical health component to this, a very critical one, but there is also a very simple issue of reducing employment opportunities for people who don’t have good teeth,” Arkoosh told Spotlight PA.

The legislation has yet to advance in the Republican-controlled state Senate.

A spokesman for Senate Republican leaders and state Sen. Michele Brooks (R., Mercer), who chairs the Health and Human Services Committee, did not respond to requests for comment on the proposed expansion.

“We’re being stingy and stupid with dollars,” state Senate Minority Leader Jay Costa (D., Allegheny) told Spotlight PA.

Costa also has a bill that would restore previous dental coverage, but urged his colleagues to prioritize the state House legislation when they return to Harrisburg later this month.

90.5 WESA partners with Spotlight PA, a reader-funded collaborative newsroom that produces accountability journalism for all of Pennsylvania. Learn more at focopa.org.