Arletha Chapman gets fitted for new dentures. (Algerina Perna / Baltimore Sun)
Jocelyn Chapman's 86-year-old mother needed major dental work, and her family was trying to figure out how to pay for it.
Medicare and Medicaid don't cover most oral health care. Arletha Chapman's dental insurance plan covered so little, her daughter said, it "was a waste of money." Most dentists wouldn't even accept the insurance.
Only after learning about a clinic at the University of Maryland School of Dentistry that offers geriatric patients a discount on treatments was Jocelyn Chapman able to take care of her mother's teeth.
Clinic staff pulled five of Chapman's teeth and are fitting her for dentures. The clinic charged about half the $3,000 that private dentists had quoted, and allowed her to go on a payment plan.
"It would have cost us a fortune otherwise," Jocelyn Chapman said.
Dental and health professionals worry that other elderly people in Maryland aren't getting the care they need because they can't afford it.
Those concerns have prompted the state Department of Aging and Department of Health to explore ways to expand senior citizens' access to dental care.
Children from low-income families in Maryland get dental coverage through Medicaid amd the Maryland Children's Health Program.
Some advocates hope that legislation passed in the General Assembly this year could lead to expanded coverage. Lawmakers agreed to study the possibility of expanding insurance coverage for dental care through Medicaid, the federal- and state-funded insurance program for low-income people.
Sen. Thomas M. "Mac" Middleton, chairman of the Senate Finance Committee and the bill's sponsor, said he hopes the study will show that the state could save money by providing dental coverage, because it would be cheaper than people ending up in the emergency room with serious problems that could have been prevented with routine dental care.
Supporters say the legislation signals that oral health is an important component of overall health care.
"Most dental conditions can be prevented through good regular home care plus visits to the dentist," said Dr. Gregory McClure, dental director at the state Office of Oral Health. "We are trying to tell people they shouldn't neglect oral health. It should be right up there at the top of the list when maintaining your health."
Officials say many elderly people aren't getting appropriate care. The state's aging and health departments surveyed nearly 1,000 adults aged 50 and over at senior centers, nutrition centers, assisted living centers and nursing homes and found many were going without care.
Officials found that 46 percent of Marylanders living in nursing homes had untreated tooth decay. Twenty-four percent of those surveyed at nutrition sites had severe inflammation of the gums.
Janet Yellowitz, director of special care and geriatrics in the University of Maryland School of Dentistry's Department of Oral Surgery, says regular dental care is particularly important for the elderly because many have a hard time taking care of their teeth on their own.
Medical conditions such as arthritis make it hard to grasp a toothbrush, Yellowitz says. Those with dementia may forget to brush.
Mobility problems and transportation may also keep the elderly from getting to the dentist.
Poor dental hygiene can lead to a host of dental and other health problems. dentists say. Untreated cavities, gum disease and tooth decay increase the risk of infections. These infections can spread into the blood stream.
Dental problems also can exacberate other conditions, making it harder for diabetics to control glucose levels. Dentures that don't fit well can make it difficult for the elderly to eat, causing excessive weight loss.
When untreated problems flare up, patients may end up in the emergency room, where the American Dental Association says treatment costs three times as much as at a dental clinic.
"Too many of the elderly ignore the dental disease for a while and it never gets better," Yellowitz said. "If there were Medicaid coverage, it would be a different world."
While most states require providers to offer preventive dental coverage to adults through Medicaid, Maryland does not. Some of the managed care organizations that handle care for the state's Medicaid patients have chosen to provide such coverage, but it can vary from year to year, and doesn't cover all procedures.
In 2016, seven of the eight managed care organizations covered up to two exams and cleanings per year, fillings and extraction. But four organizations capped what could be spent to between $150 and $750. One required patients to pay 30 percent of the cost of fillings and extractions as coinsurance.
A Medicaid recipient in Maryland can get emergency coverage for dental problems. But a patient who goes to the emergency room for dental care typically gets only antibiotics or pain medication, according to Robyn Elliott, public policy consultant with the Maryland Dental Action Coalition. The underlying dental issue is not treated.
The nonprofit backed the legislation to study expanding dental coverage for adults.
The bill authorized the Maryland Dental Action Coalition to study the annual cost of emergency room visits to treat dental conditions to help determine whether Medicaid should be expanded to cover dental care for elderly people and other adults with incomes at or below 133 percent of the federal poverty line, or $32,718 for a family of four.
Medicaid paid about $11.7 million for emergency room visits related to adult dental complaints in 2013 and $15 million in 2014, according to the Maryland Medicaid Management Information System.
The Maryland Dental Action Coalition must present its findings to the Maryland Department of Health and state lawmakers by Dec. 1. If the findings show a need for more coverage, the law authorizes Medicaid to begin offering it in 2019. The law would be subject to the budgetary process and the availability of funding.
"It is not mandated," Elliott said. "From a very technical standpoint, the governor can put anything he wants in the budget. But it expressly has the legislature endorsing the concept if he does."
Middleton says he hopes the study will bolster the argument for expanding dental coverage.
"If the numbers come back to show that there is a savings and we spend more by having people show up in the ER, then we start working with the governor," he said.
Suppporters say the legislation is a start toward better care.
Dr. Charles Doring, a Rockville dentist who specializes in geriatric care, said Medicaid coverage could help prevent basic dental issues from turning into larger health problems. He treats many elderly patients at nursing homes, which removes some of the physical barriers to care. But cost remains an issue, he said.
"The legislation is a step in the right direction," Taylor said. "We are paying money for people to go to emergency rooms when they should be in the dentist chair."