House bill would increase Medicaid recipients access to timely dental care, proponents say

David Gikovatyi, the Denture lab manager, works on a new set of dentures at the Affordable Dentures lab on January 12, 2009 in Pembroke Pines, Florida. (Joe Raedle | Getty Images)

A bill moving in the House of Delegates would help Medicaid recipients get timely access to needed dental care, proponents say.

House Bill 4933 would make it so that dentures do not count against the $1,000 yearly cap that Medicaid recipients have for dental coverage. Medicaid currently covers diagnostic, preventative and restorative dental services, with the exclusion of cosmetic services.

The bill, sponsored by House Health Committee chairwoman Del. Amy Summers, passed in the Health Committee Thursday and in the Banking and Insurance Committee Tuesday.

The legislation has the support of the West Virginia Dental Association, a statewide dental professional organization.

Director Hallie Mason said currently Medicaid reimburses dentists around $600 for an upper denture and $600 for a lower denture.

“So you can see the math problem, right?” Mason said. “If someone needs a new set of dentures, they can’t get both the upper and the lower plate in one year. That is not the standard of care in dentistry. In dentistry, if someone needs a set of dentures, you need to make them at the same time. If you don’t, it causes issues with the patient’s bite, with chewing, the teeth might not set up properly.”

Having to get upper and lower dentures in separate years also means more dental appointment visits with the potential of having transportation issues, Mason said. She said several dentists have said that they’ve made dentures for Medicaid patients and then can’t get the patient to come back and get them.

“And so, the dentist has spent the money making the denture, paid the lab fee and they can’t get people to come back in,” she said. “So really, getting dentures made in the most efficient way possible is best for the patient, and obviously best for the practice who’s seeing them.”

Dr. Wayne Dunn, a Parkersburg dentist, told the Health Committee Thursday that currently, with dentures counting against it, it takes “no time” for Medicaid patients to hit the $1,000 yearly cap.

“So if it’s exempt from that, that gives that $1,000 for the needs of the patient,” Dunn said. “And believe me, they run through that quickly. If someone is going to have a denture, they need it, then usually the teeth have to come out. They’ll run through the $1,000 quickly.”

Exempting dentures from the cap would help prevent Medicaid recipients from having to put off getting dentures, he said.

The bill is similar to policy in the state of Iowa, where cleanings and emergency procedures are also exempted from the cap, Mason said.

“We’re not asking for all of that. I think we just want to make sure that people can get their dentures in a good, reasonable time period,” Mason said. “So this bill would do that.”

The bill will next go to the full House of Delegates for consideration.

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