Marcia Esters needs crowns fused to six of her bottom teeth and new dentures. But because of changes made to Medicaid in Pennsylvania, she now has to pay for it all herself.
"It's thousands of dollars' worth of work that I cannot afford," she says.
Esters also uses a wheelchair. Because she couldn't get get her teeth fixed, she has spent the last few months eating pureed food and avoiding people.
"I don't go anywhere unless I have to," she says. "If you could look or feel halfway decent, it just helps, it really does."
Medicaid, a program funded jointly by the federal government and the states, covers the poor and disabled. Coverage varies by state.
Most states don't pay for any dental care. Pennsylvania does. But Republican Gov. Tom Corbett has reduced the coverage for 2 million adult Medicaid patients to basic dental care.
The changes have eliminated coverage for root canals and periodontal disease work, and limited the number of dentures a patient can receive. The plan now covers little more than cleanings, fillings — and extractions.
The Pennsylvania Department of Public Welfare estimates it is saving $42 million this year. "We can't keep up with the spending that is going on," spokeswoman Anne Bale says. "So we have to limit the number of procedures people have so we can ensure the program for the future."
The state allows people to petition for help. Since last fall the state has received more than 7,500 appeals. Most have been denied, including one filed by Esters.
Surveys show people with disabilities have a harder time seeing a dentist than any other group. Part of the problem is cost: Many dentists don't take Medicaid since it doesn't bring in a lot of money.
And there are other issues. A dentist's office may not be able to easily accommodate someone in a wheelchair. Patients with behavioral issues may require sedation that only an anesthesiologist can provide.
Lynne Taiclet, who runs the Center for Patients with Special Needs at the University of Pittsburgh's Dental School, says these are actually relatively new problems for dentists.
"Patients that live in group homes and in their families' homes now didn't do that 40 and 50 years ago. They were institutionalized at a young age, and the institutional setting took care of their medicine, their dentistry, all of it."
Esters is hoping that a charity will help with her dental expenses or else she'll have to have her remaining bottom teeth removed.
GUY RAZ, HOST:
Now, while the Affordable Care Act will expand Medicaid, dental care for adults is not offered with Medicaid in every state. Pennsylvania is one of the few places that has provided it. But because of budget cuts, the state is now offering only the most basic dental coverage for adults on Medicaid. Essential Public Radio's Erika Beras has the story of one woman affected by that change.
ERIKA BERAS, BYLINE: Marcia Esters gets around in a motorized wheelchair because of a spinal disorder that got worse after a workplace accident. Last fall, she went to her dentist. He told her she needed crowns for six of her bottom teeth, and her top dentures were wearing out. And because of changes made to Medicaid in the last budget, she would now have to pay out of pocket.
MARCIA ESTERS: It's thousands of dollars that I cannot afford. I have one income, and my family is poor.
BERAS: Over the last few months, her teeth have gotten worse. She can only eat pureed food, and she's isolating herself.
ESTERS: I don't go anywhere unless I have to. You know, people look at you when you're in a wheelchair, or have to have the kind of assistance I have, anyway. But if you could look or feel halfway decent, it just helps. It really does.
BERAS: Medicaid coverage varies by state. Most states don't cover any dental care. Last year, Gov. Tom Corbett reduced dental benefits for Pennsylvania's 2 million adult Medicaid patients to just basic dental care - eliminating root canals, periodontal disease work; and limiting the number of dentures a patient can receive. The plan now only covers cleanings, fillings and extractions. The state estimates this is saving $42 million a year. Anne Bale is from Pennsylvania's Department of Public Welfare.
ANNE BALE: While we know we have a good benefit, we have to limit it, somehow and someway. We can't keep up with the spending that is going on with this dental benefit. So we are looking to limit the number of procedures that people have so we can, you know, ensure the program for the future.
BERAS: The state allows dentists to petition for additional funds if the dental condition will severely worsen a patient's chronic illness. Since last fall, the state has received more than 7,500 petitions. Most were denied, including Marcia Esters'.
Surveys show people with disabilities - with both private and public insurance - have a harder time seeing a dentist than any other demographic. That's because most dentists don't take patients on Medicaid. There are other issues as well. Patients with behavioral issues may require sedation for basic care, that only an anesthesiologist can provide. Not all dental offices are able to accommodate someone in a wheelchair.
LYNN TAICLET: This is a Hoyer lift, if somebody's - can't transfer from a wheelchair to a dental chair. You actually have, like, this...
BERAS: Lynn Taiclet runs the Center for Patients with Special Needs at the University of Pittsburgh's dental school. She says many dentists never had to learn to work with this population.
TAICLET: Patients that we see, who live in group homes and in their families' homes now, didn't do that 40 and 50 years ago. They were institutionalized at a young age. And the institutional setting took care of their medicine, their dentistry - all of it.
BERAS: Marcia Esters is hoping that a charity will help with her dental expenses. She's already struggling with digestive issues and depression, but treatment for those is covered.
For NPR News, I'm Erika Beras.
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RAZ: This story was produced in collaboration with Pittsburgh's Essential Public Radio, and Kaiser Health News.
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RAZ: And you're listening to ALL THINGS CONSIDERED, from NPR News. Transcript provided by NPR, Copyright NPR.