New Haven Independent

The bad news will be worse for patients and clinics like Hill Health if the state legislature approves a dental cut proposed by Gov. M. Jodi Rell. Rell has proposed eliminating non-emergency dental care for low-income adults as part of her effort to balance the state’s budget for the biennium beginning July 1.

Patients are likely to have more emergencies, which would mean more pain and higher costs to the state rather than the $51 million savings over two years the governor is predicting, advocates for the poor and poor patients themselves argued this past week.

Toward the end of the Hill Health Center dental clinic’s hour-long lunch break on Friday, patients milled outside the locked door, then, when it opened, made a beeline for registration.

“I have a hole in a tooth, with a raw nerve,” said Jim Raccuglia (pictured), who recently arrived in New Haven, where his father lives, after 11 years in New Orleans. Told about the potential cuts, he said it was short-sighted. “Then you’re going to have to pay a lot more money in the long run, and the maintenance will keep us able to eat and function on a regular basis.”

Raccuglia just got on SAGA, the state’s medical insurance program for low-income single adults. Before that he didn’t have any insurance, “so I didn’t do anything” about the tooth, he said.

Mercado said he would refer Raccuglia to get the abscessed tooth pulled. In the meantime he would give him a prescription for an antibiotic to reduce the inflammation. And staff at the clinic would provide routine care. He said he hoped that would prevent similar problems with other teeth down the road. But not if the cuts go through.

Madeline McClave, interim executive director of the Connecticut Oral Health Initiative (COHI), was one of many providers who testified at a hearing last Wednesday before the General Assembly’s Appropriations Committee in Hartford. She opposed eliminating routine care for the 230,000 adults enrolled in HUSKY, SAGA, Medicaid fee for service and Title 19.

McClave predicted it would actually cost the state more money to do that, citing what happened following a similar cut in Maryland. There the number of emergencies increased. She mentioned several other concerns, including the relation between poor oral health and health problems such as “heart disease, diabetes, systemic infection, pneumonia, and more.” She added that “studies show that dental disease is linked to pre-term births, low birth weight babies and other delivery complications.”

“Dental caries is an infectious disease that should be prevented through our public health system and not be allowed to go unchecked,” she added. “Caries is a disease caused by specific bacteria. It results in cavities. The bacteria is transmitted from parents to newborns and young children, infecting them and continuing the cycle of decay and disease. It is the single most common health condition affecting children in the U.S.”

Finally, she pointed to the negative impact of eliminating routine dental care on adult nutrition, employability and self-esteem. Click ">here to read her complete testimony.

She urged legislators to consider the proposals to generate income for the state presented by the Better Choices for Connecticut Coalition, initiated by Connecticut Voices for Children. Among other things, it calls for a “millionaire’s tax.”

McClave concluded her testimony with this plea: “The increased Medicaid funding coming to Connecticut from the federal stimulus package is intended to pay for this kind of health care for our low-income residents and should preclude your having to make these cuts.”

Ruben Gonzalez of Hamden (in the chair) is on SAGA and was at the clinic getting his teeth cleaned. The dental hygienist working on him, Joanne Cerrone, said what originally brought him in was a toothache. He had the tooth pulled. “This is the beginning of his routine care,” Cerrone said, but it may be the end if the governor’s proposal goes through.

In an interview in his office before seeing Raccuglia, Dr Mercado said, “We see a lot of people with a lot of decay in their mouths and it has to be taken care of. It’s only going to get worse if it’s not treated. Nobody wants to see this population.”

He added, “How much can you push someone who’s already in a corner? I’m leery of the fact that if you don’t treat people who are underprivileged, they’re going to somehow strike back. I’ve been serving these people for 30 years; they’re grateful; they need the services. They don’t come here and get elaborate treatment; we do what’s necessary to make them comfortable and so they can become employable.”

Department of Social Services spokesman David Dearborn respoded in an email message, “DSS is the biggest part of the state budget, and we currently spend nearly $4.3 billion annually on public health care alone. In a crisis of this magnitude, it’s important to recognize that the Governor’s budget recommendation preserves current benefits — including dental —- for the 237,000 children and teenagers in HUSKY. It’s equally significant that the Governor has included funding for the expected enrollment increases for children and parents over the budget biennium.

“Her budget also maintains Connecticut ‘s relatively high income-eligibility standards — including the fairly recent increases for parents and pregnant women. To help afford these priorities, the budget recommendation limits dental benefits to adults in Medicaid and State-Administered General Assistance to emergencies — which are defined to include dentures, x-ray, limited oral evaluation, emergency treatment for dental pain, and extractions. Savings are estimated at $50.7 million over two years. Most other states never provided dental benefits in the first place. Certainly, no one is happy about the need to make these budget choices, but difficult decisions have to be made nonetheless because we are in a sea of red ink.”