How a ruling stopped pregnant AZ moms from getting dental care


Corrections and Clarifications: The dental benefit that was cut during the Great Recession was inaccurately described in an earlier version of this article. It was a $1,000 emergency dental benefit.

When Stephanie Parham was a 20-year-old mother, determined to protect her daughter Angelica from the kind of tough childhood she endured, public health insurance for low-income families helped them stay healthy.

Parham, whose braces went untreated as a homeless teenager, needed dental repairs for damage that had worsened after giving birth. Women who become pregnant often face dental problems due to rapid hormonal changes, health experts say.

After Parham turned 21, however, the state health care program cut off his dental benefits.

Eliminating already limited dental benefits for the roughly 1 million adults over 21 who receive coverage through Arizona’s healthcare cost containment system was a cost-saving measure taken by the Arizona legislature during the Great Recession.

The decision made more than ten years ago marked Parham’s life.

Unable to afford necessary dental treatment, Parham often avoided seeking treatment until the pain was unbearable, she said. Once she had a tooth extracted in the ER and other times she traveled to Mexico for cheap but sometimes inferior treatment.

Now, at 35, Parham continues to deal with the damage and is raising thousands of dollars to pay for implants to replace her missing teeth.

“If my dental insurance (Medicaid) hadn’t been cut, I wouldn’t be here right now,” Parham said. “I would have felt blessed and grateful to have that blanket. I wished I had my teeth done. (Instead) it was so expensive that I got discouraged.”

Since 2017, the Arizona legislature has considered proposals to provide routine teeth cleanings and dental care to pregnant women.

But every year the bills fail. The objection is largely on the cost.

The decision by political leaders to withdraw a limited $1,000 emergency dental benefit for adults from the AHCCCS in 2010 and not cover preventive care, including when the state budget is in surplus, frustrates Parham .

“This decision affected me,” she said. “It’s really upsetting. It really hurts me.”

Campaign to restore dental benefits for pregnant women

A bipartisan coalition of lawmakers, health advocates and charities has been pushing to provide comprehensive dental benefits to Arizona’s poor.

Lawmakers agreed in 2017 to restore emergency dental benefits that were cut during the Great Recession and to reimburse $1,000 per adult covered by Arizona’s Medicaid program for procedures such as root canals and oral surgery. But the benefit doesn’t apply to regular exams or fillings, and many emergency procedures cost more than $1,000.

Since then, advocates have called on the state to expand routine dental care to pregnant women.

The good it would do for women and babies would be enormous, according to Jessie Armendt, who represents March of Dimes, a nonprofit organization founded in 1938 by President Franklin Delano Roosevelt to fight polio that now promotes maternal health and infant.

According to the American Journal of Maternal/Child Nursing, a striking finding from medical research is that pregnant women with gum disease are more likely to give birth prematurely, have low birth weight babies, and may even transmit harmful bacteria to their infants. Regular tooth cleanings can reduce these risks.

“When you look at oral health care as a whole, it’s so cheap to provide that preventative care, and it can have such a huge impact on a patient’s health,” Armendt said. “We’d love to prevent all preterm births statewide, but even if we can just make a real cut, you get back the dollars you spend pretty quickly.”

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Rep. Kelli Butler, D-Paradise Valley, who owns a dental practice, joined Republicans and Democrats in the Legislature to advocate for change.

But even though bills to provide dental care to impoverished pregnant women frequently draw hundreds of public supporters compared to a handful of opponents, the legislation never gets far, Butler said.

“It’s absolutely disconcerting that we don’t prioritize this,” Butler said. “I don’t understand why we wouldn’t consider the health of your mouth the same as the health of other parts of your body. … It makes moral and fiscal sense to offer this benefit to pregnant women.”

Opposition from GOP legislative leaders is unclear but appears to be focused on the cost, she said. The AHCCCS estimated that the state could pay about $4.1 million to extend dental benefits to low-income mothers in one year.

But with thousands of preterm births in Arizona and neonatal intensive care costs of up to $25,000 per preemie, Armendt said, preventing even a fraction of early births through Medicaid dental benefits could offset many times over. state spending.

cost concern

Rep. Regina Cobb, R-Kingman, a former dentist, helped co-sponsor the bills.

Pregnant women experience more changes in their oral tissues than at any other time in their lives, she said.

“You have to have a healthy mother to have a healthy baby,” Cobb said.

While she said many lawmakers believe in the value of dental care for pregnant women, some have questions as cost estimates have fluctuated and it’s unclear how many women could be helped, a- she declared.

A concern this year was that the bill did not include a price limit, Cobb said. Previous bills capped routine dental coverage for a pregnant woman at $1,000.

The estimated total cost per year for dental appointments is actually quite low, about $470,000, according to the AHCCCS budget staff.

Most of the cost comes from the possibility that hundreds, if not thousands, of women who did not previously seek prenatal care through the Medicaid system or who had not yet informed the state that they were pregnant could jumping at the chance for dental care, budget staffers told lawmakers.

If that happened, the state would have to pay for more members. The state could also lose money because the federal government reimburses care at a lower rate for pregnant women than for non-pregnant women.

Some lawmakers have questioned the likelihood that so many pregnant women who weren’t already visiting a doctor would see a dentist. But the budget staff said it was possible.

Others pointed out that it would be positive if dental benefits encouraged pregnant women to seek treatment before they were born.

Although Bill is likely dead this year, he could be successful next year, Cobb said.

“Let’s bring the price down,” she said.

A pressing need


Dozens camp for free dental care at State Fairgrounds

A string of tents line a street near the Arizona State Fairgrounds in Phoenix on December 6, 2018, outside a free dental clinic on December 7.

Sean Logan, Arizona Republic

Ideally, Arizona would provide comprehensive dental care to all low-income adults, advocates say.

Missing, broken or dirty teeth can impair people’s ability to get good jobs, eat healthy foods, take care of other health issues and maintain trust and relationships, among other negative effects, the report said. Dr. Ken Snyder, executive dental director of St. Vincent de Paul’s free dental practice.

“The impact it (dental care) has on people can be life changing,” Snyder said. “What we’re really doing is giving them hope for a better future.”

The demand for affordable dental care in Arizona is huge, he said. Even when St. Vincent de Paul doubled the size of its dental clinic in 2019, it saw nearly 2,000 patients that year and still had a waiting list.

Hundreds of Phoenix-area residents regularly camp overnight for free care at Dental Mission of Mercy events at the Veterans Memorial Coliseum.

Midwestern University at Glendale, whose student dentists provide low-cost dental care to the public, sees about 15,500 patients a year.

The number of uninsured Arizonans visiting hospitals for dental emergencies is so large that Delta Dental of Arizona announced in January that it would donate $525,000 to divert patients from HonorHealth emergency rooms to community dentists.

The effort wins a supporter who “lived it”

Dental care should be considered just as important as other medical care, Parham said.

Parham said she wanted to use her personal experience as a low-income pregnant mother whose dental benefits were key to convincing Capitol lawmakers to approve the legislation.

“They’re not living it. They’re sitting comfortably,” Parham said. “I’ll go down the street. We’ll walk up there.”

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Consumer journalist Rebekah L. Sanders investigates fraud and abuse issues involving businesses, healthcare and government agencies. Contact her at [email protected] or follow her on Twitter at @RebekahLSanders.

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