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Medicaid,
QUEST: Pull,
don’t fill teeth

The plans provide only
emergency dental care, and
fillings don't qualify

---

By Helen Altonn
Star-Bulletin

Hawaii adults on Medicaid or the state's QUEST health care plan may be getting teeth pulled instead of filled so the cost can be covered.

"The only option to coverage may be extractions," Mark Greer, the state's chief dental officer, acknowledged at a legislative briefing.

Only emergency dental service is provided to adults on Medicaid and QUEST. Fillings aren't covered, but surgeries are, Greer said.

Rep. Mark Takai (D, Waimalu-Waiau-Newtown) raised the issue after describing a QUEST client who had a toothache and was told the only way to fix it was to extract it. "My guess is he didn't need extraction," Takai said.

Beth Giesting, executive director of the Hawaii Primary Care Association and the head of a Statewide Oral Health Task Force, said nearly 300,000 Hawaii residents have no basic dental care coverage.

They include 79,000 adults with QUEST or Medicaid coverage who get only emergency dental service.

Restoring dental benefits to adults in the government programs is one of five task force recommendations to improve Hawaii's oral health -- among the worst in the nation.

'Not one magic bullet'

The chairman of the House Health Committee, Dennis Arakaki (D, Kamehameha Heights-Kalihi Valley), said legislators must look at a comprehensive strategy. "There is not one magic bullet. Even with fluoridation, it doesn't solve the adult problem," he said.

Arakaki's committee and the House Committee on Human Services and Housing, chaired by Rep. Michael Kahikina (D, Nanakuli-Maili-Waianae), held a briefing Friday on the state's oral health.

Fluoridation of the water supply -- a proposal rejected last year by the Senate -- heads the task force recommendations.

Various speakers Friday again advocated fluoridation as a major solution to tooth decay among children. Arakaki said the controversial proposal wasn't up for discussion at the briefing, but he will hear a fluoridation bill.

Other recommendations:

Provide a waiver that allows licensing of dentists by credentials for service in dental safety net facilities.
Develop and support dental services at community health centers.
Increase dental reimbursement rates -- among the lowest in the nation -- to attract Medicaid and QUEST dental providers.

Arakaki expressed concern about use of $1 million appropriated last year for oral health care in under-served areas and on the Neighbor Islands.

"We found out it is being used for other purposes and the money has not been spent yet, and half a year has gone by," he said.

Help for Queen's clinic

His concerns stemmed from an agreement by the Department of Health in December to give about $400,000 to the Queen's Medical Center's dental center in the next fiscal year to keep it from closing.

The only clinic of its kind in Hawaii, it provides dental services to the poor and disabled, disadvantaged youths, prisoners and others with special needs.

Deputy Health Director Virginia Pressler said documentation is expected from Queen's by Jan. 31 to justify state fiscal help. Meetings also have been held with the University of Hawaii medical school to seek federal funding to support a dental residency program, she said.

She said $300,000 will be spent to develop dental health services at community health clinics on the neighbor islands.

About $125,000 is needed for administrative expenses involved in contracting with dentists to serve the disabled in a demonstration project, she said.

So far, 36 dentists have been recruited, including 27 on Oahu, two on Molokai, four on Kauai and three on the Big Island. Also, three on Maui and one on Lanai are interested, Pressler said.