Medicaid’s Dental Gap Kept Her from Smiling

MADISON, Wisc. (WOMENSENEWS)– Morgan Ernest’s teeth began to deteriorate when she was in her 20s, most dramatically after the births of her two daughters.

It wasn’t as though she’d neglected her teeth. Throughout her childhood, while growing up in Chicago, she brushed twice a day, used mouthwash daily and saw a dentist regularly.

Nonetheless, her teeth began to crack or break off entirely, leaving only the roots. "I did eat a lot of candy, but I inherited bad teeth from my mom," she said. "My dad doesn’t have this problem."

Having good or bad teeth is largely due to genetics. For some women, pregnancy can cause problems when a growing fetus takes nutrients from throughout the mother’s body, including her teeth.

Ernest granted Women’s eNews an interview in the place she currently calls home; a local Salvation Army shelter for single women where she’s been living off and on since 2012. As her financial situation deteriorated, she began to see dental care as a luxury.

By her early 30s her teeth were like little brown sticks, according to staff members at the free dental clinic that eventually helped her.

"People were shocked when they saw my teeth because they’d never seen anything like it," Ernest said. "I was always being asked if I was on drugs. I wasn’t insulted because I already knew what they were thinking, but it’s not exactly a conversation starter. The worst thing was when kids asked me why my teeth were so rotten."

By her early 30s she also knew that the infections in her gums could spread their poison into her bloodstream and kill her.

During at least five trips to emergency rooms she was given a narcotic painkiller and antibiotics. Then she was sent home and told to see a dentist or oral surgeon.

That, however, was impossible for her.

Wisconsin has one of the lowest Medicaid reimbursement rates for dental services in the nation, a situation exacerbated by Gov. Scott Walker’s refusal to accept federal money to fully expand the public health insurance program in the state. Dental care reimbursements to providers in Wisconsin are so meager that they typically don’t even cover dentists’ costs for equipment, staff and facilities.

Low Payments, Lots of Complications

Aaron Warren, executive director of the Madison Dental Initiative, a nonprofit service provider, said very few dentists in the Madison area accept Medicaid patients because of the low reimbursements as well as the state’s bureaucratic complications, which demand X-rays and pre-authorizations.

Fifteen percent of the U.S. population lives in areas with a shortage of dental health professionals, finds a 2012 fact sheet by the Kaiser Commission. While dental benefits are mandatory for children on Medicaid, the commission notes that adult dental services are covered as a state option. "Most states provide some adult dental benefits, but half restrict their coverage to emergency services, and adult dental benefits are frequently cut or eliminated when states face budget pressures," says the fact sheet.

As her teeth got bad in her 30s, Ernest’s life started falling apart in ways she considers related.

Her decimated smile didn’t help her in job interviews. "I could see on their faces that they were wondering what was wrong with me," she said. After her daughters moved in with their father, Ernest, who did not finish high school, moved to Madison three years ago to be near her mother. The best work she could find there was as a part-time janitor.

Having ravaged teeth was more than a cosmetic problem and a hindrance to employment. It was also hurting her health. She couldn’t eat anything hard and was continuing to lose weight.

"I had abscesses that caused excruciating pain. My face would swell so it looked like someone hit me," she said. The swelling was at times so extreme that she wondered if she’d been bitten by a venomous insect.

Things started getting better recently after a caseworker at the shelter told Ernest about Madison Dental Initiative, which operates in borrowed space in the Salvation Army building occupied by the homeless shelter.

Founded in 2009 and funded by foundation grants, donations and volunteer services from practicing dentists, dental school externs and dental hygiene students, Madison Dental Initiative now has three chairs and last year provided $333,000 in free dental services.

"We case manage," said clinic manager Curtis Henderson. "Some people don’t know how to use the bus system, so we give them rides. They have all kinds of stress, and I usually repeat everything they need to know four times. There’s a lack of oral health literacy. And it’s hard to keep track of people who need help if they don’t have an address or their phone is out of order."

Smile, Confidence Back

So far Madison Dental Initiative has provided Ernest with $4,511 worth of care, with just 2 percent of that reimbursed by BadgerCare, Wisconsin’s Medicaid program.

All her upper teeth were pulled and she was fitted with a denture. "It was weird and exciting," she said. "It was like seeing myself for the first time. I got my smile and my confidence back."

And she also got a new job at a clothing factory that pays better than her old janitor work, and which she said she enjoys and is two blocks from the shelter. "I’m trying very hard to prove myself. I can’t explain how grateful I am."

This summer, the 10 remaining teeth in her lower jaw will be extracted and she’ll receive a lower denture.

After the interview finished in a conference room at the shelter just before 8 p.m. Ernest moved on to the next part of her daily routine: setting up her cot in the gym, gathering up her belongings in order to keep them safe and ready for the next day and take a shower.

Other people in the state who also need subsidized dental care may be stuck where Ernest was not so long ago, but with less free dental care available.

The Max W. Pohle Dental Clinic at Meriter Hospital in Madison, which offers subsidized care, is shutting its doors after 40 years. It was forced to close because it was losing more than $500,000 a year. A big part of the over run was caused by patients with developmental disabilities or other conditions who required full sedation even for routine procedures.

Madison Dental Initiative’s Warren expects his clinic’s annual patient load to jump to more than 1,000 up from 700 because of the closing.

"This is a very bad situation," Warren said in a recent interview in the clinic’s offices inside the Salvation Army building, referring to the hardships of his patients. "You have people who don’t have access to a bathroom or running water. They’re standing in line wondering if they’ll be able to get a meal so their teeth are not a priority. Maybe they don’t even have a toothbrush. And the medical community breaks the body into parts. What goes on in the mouth has an impact on every part of the body."