Assessing impact of Medicaid changes in Pa.

    In September, the Corbett administration cut back dental benefits for adults in Pennsylvania’s Medicaid program.

    Critics worried the move to save money would lead to serious health problems for some of those Medicaid participants.

    This week, after eight months of implementation, the Department of Public Welfare officials say there have been “no spikes” in costlier health care such as emergency room visits or hospitalizations due to a lack of dental care.

    But state officials reviewed aggregate trend data that may not tell the whole story, says Nancy Murray, president of The Arc of Greater Pittsburgh at ACHIEVA and a member of Pennsylvania’s Medical Assistance Advisory Committee,

    “Advocates and advocacy organizations are hearing the experiences of individual people,” Murray said. “We’re more concerned with the stories we are hearing from people.”

    George Kimes, also on the Medical Assistance Advisory Committee and head of the Pennsylvania Community Providers Association, wants more information.

    “I’d like to see data on the people who actually had the limitations imposed,” Kimes said.

    The changes to the Medicaid dental benefit include limits on dentures, root canal and gum disease care.

    In March there were 938 requests for an exception to limit, according to Dan DeLellis of the Office of Medical Assistance Programs. He said the state approved 155 exceptions.

    After the dental plan changes in the fall, Pennsylvania in January began limiting the medical assistance pharmacy benefit to six prescriptions each month — for adults.

    DeLellis says the state system has built-in exceptions so people are able to get critical drugs such as heart medication or medicine that fights infection for those with cancer or HIV.

    “These are all drugs that tend to treat very serious illness. And if you don’t have them, it’s pretty obvious you are going to go into a hospital very shortly,” DeLellis said. “If any of these types of meds are their seventh or greater meds, they will be approved through the exceptions process automatically at the point of sale.”

    The department intends to continue tracking the number of limit exceptions requested by Medicaid participants.

     

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