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After years of shutdown, the state is poised to provide its approximately 85,000 residents with Medicaid coverage not only for tooth extractions and emergency dental care, but also for the diagnostic and preventative care needed to ward off these serious problems.

The House and Senate gave final approval to Senate Bill 422 on Thursday, and Gov. Chris Sununu said he would sign it into law. Proponents say it is both a health care and labor bill because people with obvious dental problems may find it difficult to get jobs. Securing a job, they say, is a step toward getting off Medicaid.

“When I think of all the bills we have year after year, most of them are so obscure. They change a definition or change eligibility for a program that already exists,” said Senator Cindy Rosenwald. , Nashua Democrat and chief sponsor of the bill, who began working on this issue nearly 15 years ago “There are very few bills that have a positive and immediate impact on people’s lives. This effort will have a direct and positive impact and will financially protect over 100,000 granite staters We don’t have many opportunities to do this.

New Hampshire is one of less than a dozen states that does not cover preventive oral health care for people on Medicaid and Extended Medicaid. Two organizations have funded or found grants to provide these expanded benefits to Granite Staters, but this will be the first time coverage has been made available statewide. With federal games, additional benefits are expected to cost the state about $7.5 million or less per year.

Public support for expanded dental benefits was among the issues that dominated last year’s public hearing on the budget, but the bill providing for them fell through in the final days of the session. Sununu vetoed a similar bill in 2020 at the start of the pandemic, saying he supported the concept but was reluctant to take on new spending in times of economic uncertainty.

In a statement on Thursday, Sununu said, “Expanding coverage to include dental benefits for those on Medicaid is something I have long supported, but challenged the legislature to do so. a way where the costs are sustainable and transparent. I am grateful to them for the work they have done this session to achieve these goals and I look forward to signing the bill into law.

Gail Brown, director of the New Hampshire Oral Health Coalition, has advocated for the benefit for years.

“After years of legislative, policy, advocacy and community collaboration, SB 422 is now poised to open the door to affordable and accessible dental care for New Hampshire adults covered by Medicaid and Medicaid Expansion” , she said. “A dental benefit supports individual and family involvement in employment, education and community activities.”

If the bill gets the governor’s signature, Brown said the next challenge will be recruiting enough dentists to care for Medicaid patients, given uncertain reimbursement rates and concerns about who comes to the clinic. appointment.

Under SB 422, the state would cover annual comprehensive oral exams, X-rays or other imaging, treatment to prevent disease, topical fluoride, oral hygiene instructions, behavior management and counseling. smoking cessation. Restorative dental work, such as replacing fillings, missing or damaged teeth, crowns and bridges would also be covered, as would oral surgery necessary to relieve pain, clear infections or prevent impending tooth loss.

Access to this wide range of care is what Medicaid recipients and their families have been calling for for years. That includes Julie Hilliard of Claremont, whose adult son Cameron can’t get coverage until his dental issues get bad enough to land him in hospital.

“What’s covered in New Hampshire is that they’ll come in and pull the tooth out,” she told the Bulletin in November. Even then, cleanings aren’t covered, Hilliard said. An anesthetist offered a solution, telling Hilliard she should have all of her son’s teeth pulled and be done with it.

“He might even learn to eat steak without teeth,” Hilliard recalls.

ABLE NH, which advocates for people with disabilities, said the bill demonstrates bipartisan agreement that health equity is also fiscally prudent public policy.

“ABLE NH is very proud to have been part of the team that achieved this positive step forward in oral health policy for Granite State’s most vulnerable citizens – Medicaid recipients,” said Executive Director Lisa Beaudoin. “For the disability community, access to preventative and restorative oral health care means eliminating the need for expensive emergency care for dental infections due to cavities. not treated. A healthy, pain-free mouth will lead to improved employment rates for people with disabilities as well as improved overall health care outcomes.

SB 422 calls for using nearly $21 million in settlement money, guaranteed by the state in January against a company hired to administer Medicaid drug benefits, to cover the first three years.

The new benefits would not have a cap on benefits or co-payments for preventive services. Other dental care would be capped at $1,500 per year and require an as yet unspecified co-payment for people with household incomes above 100% of the federal poverty level, or $27,750 for a family of four. .

Coverage for dentures would only be provided to Medicaid recipients with developmental disabilities, acquired brain disorders, and those in the Choices for Independence program, which includes seniors and those with chronic conditions or disabilities.

Extended benefits would begin in April 2023.

Brown said the coalition would have preferred there to be no copayment, but was pleased to see preventative services excluded from that. She called the bill acceptable, given the other coverage she and others have spent years advocating for.

“We have to start somewhere,” Brown said.

The state’s dental community supported the legislation for expanded benefits, but dentists here and nationwide have raised a number of concerns, Brown said.

They worry about low reimbursement rates that don’t cover services, which other primary care centers and hospitals have long considered a problem. Missing appointments is another barrier, as this population may struggle to find transportation or face other barriers, such as not being absent from work.

“The target population probably doesn’t have the resources to be there 100% of the time,” Brown said. “It’s a valid concern because an empty chair is an empty chair.”

To help with that, dentists want Medicaid to provide care management that reminds patients of their appointments and makes sure they have transportation.

AmeriHealth Caritas, a Medicaid-managed care organization that began work in New Hampshire in 2019, provides preventive, diagnostic, and basic restorative and periodontal care to its adult members.

Aspire Living and Learning, a nonprofit that provides treatment and supports for people with intellectual and developmental disabilities, has received $19,000 in grants from the Northeast Delta Dental Foundation, Bangor Savings Bank and Cogswell Benevolent Trust to provide comprehensive dental care for adults on Medicaid it serves.

John Whittemore, the program’s senior operations manager, said Aspire Living and Learning was able to help 11 people for their 18 appointments. The association pays service providers directly and provides transport for its clients to appointments.

“These grants have given the people we serve access to dental care that they would not have had access to through Medicaid, including preventative care,” Whittemore said.

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