Vetoed Medicaid dental benefits will continue for another month, raising questions about cuts

The state quietly announced late last week that it will be continuing to cover preventative dental procedures for Medicaid beneficiaries through the end of September even though Gov. Michael J. Dunleavy’s veto completely eliminated all funding for the program.

It’s good news for people like Michael Shelden, who was caught on the wrong end of the governor’s initial June 28 veto of the program leaving him in the middle of a dental procedure with no teeth, no dentures and no path forward thanks to the abrupt end of the adult preventative dental program.

All beneficiaries of Medicaid will be able to take advantage of the program through Oct. 1, regardless of whether they started services prior to the “end” of the program. The extension had not been previously announced, and many health care providers had been under the impression the program was gone.

Still, it raises questions about the mechanics behind the announcement.

Did the governor find a way to magically spend money that he doesn’t have? All money for the program had been terminated with the governor’s veto, after all.

Or, as columnist Dermot Cole pointed out last week, did the administration fail to file the necessary termination notice with the Centers for Medicare and Medicaid Services that’s required when ending any and all benefits and has to continue the program for the first quarter of the fiscal year because of that failure?

Either answer should raise alarm bells with legislators. Either the governor is spending money that the Alaska Legislature hasn’t appropriated, or his administration once again been caught between reality and its overpromises about how much and how quickly it can cut Medicaid spending, forcing it to spend money it cut?

Medicaid rules require recipients be notified at least 10 days before benefits are set to end, and Dunleavy didn’t announce his veto of the adult dental program until three days before the start of the new fiscal year. The termination notice was never filed and has yet to be filed for the upcoming end date of Oct. 1, but the state’s website says beneficiaries will be notified this time around.

Benefits also can’t be cancelled mid-quarter, so the program has technically been alive for the last two months and claims submitted after July 1 that were denied will be reconsidered, according to the state.

The whole turn of events was news to Dr. David Logan, executive director of the Alaska Dental Society, who told the Anchorage Daily News that he hadn’t been told about the extension. He, and the rest of Alaska, had been under the impression that it stopped on July 1.

“It’d be great news if it’s true,” he told the newspaper. “It’d be even better news if they’d share it with the providers. I’m thinking out loud, but if people knew it was available, they might come in and get some (dental) work done.”

Who picks up the bill?

The cost of the adult dental program to the state is $8.2 million with another $18.7 million in federal matching grants. Thanks to the administration’s efforts to conceal the continued existence of the program, it’s unlikely that people will be able to take full advantage of the benefits allowed under the program but it will mean that someone will need to pick up the bill for the program.

The spending—like the rest of the Medicaid program—will occur regardless of whether there’s funds allocated for it.

The administration is already facing scrutiny for its promises to cut Medicaid spending as part of its effort to close the budget gap. The Legislature cut about $77 million from the program, which was the maximum extent that both the state and legislators agreed was actually feasible in the current year, and the governor extended that with a veto of another $50 million.

Legislators and those in the health care industry have warned against overpromising cuts on Medicaid because much of the spending of the entitlement program is driven by use. The only way to cut spending is to reduce eligibility, terminate benefits or find efficiencies. The administration has already delayed some aspects of its cuts, meaning it will already have to return to the Legislature to cover the cuts that weren’t achievable.

“We’re concerned that the governor’s Medicaid cuts are not transparent and that they’re not real,” Alaska State Hospital and Nursing Home Association President and CEO Becky Hultberg told KTOO. “They’re not transparent because the department has not identified how it is going to achieve these savings.”

That goes, too, for these three months of adult preventative dental benefits.

Hopefully legislators get to the bottom of this when they are asked next year to pick up the tab for the administration’s errors and overpromises of cuts to Medicaid.

In the meantime, Cole has this request to dentists.

“Every dentist in the state, as a public service, should make room in September for as many Medicaid patients as possible. Having good teeth is a requirement for getting almost any job,” Cole writes. “This is a new fiscal year, so recipients qualify for up to $1,150 of preventative coverage, if it starts in September. The existence of this program saves money and lives. Without it, the state will have to provide more expensive emergency Medicaid dental services to those who let their teeth get so bad it becomes a personal health crisis. Delaying dental care leads to far more expensive and damaging health problems.”