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Uninsured Virginians may lose free dental care

By Phillip Lucas
Tuesday, July 6, 2010; B01

Advocates for uninsured Virginians say slow action from state and federal officials means that thousands of residents who could have received free dental care this summer will go unserved unless Congress intervenes.

Virginia received authorization from the U.S. Department of Health and Human Services to use money from the state's Temporary Assistance for Needy Families fund to provide dental care to uninsured residents.

The emergency fund is a federal block grant established by the American Recovery and Reinvestment Act of 2009, and it is supposed to serve as a safety net for families looking for employment opportunities and other types of assistance. Virginia requested permission to use some of the money for dental care for uninsured adults.

The Virginia Health Care Foundation submitted a proposal six months ago to use $5 million from the emergency fund to treat up to 7,000 dental patients. The state Department of Social Services reviewed the proposal and forwarded it to HHS. But HHS didn't approve the plan until June 16. The foundation backed out, saying the delay didn't leave enough time for clinics to schedule appointments and complete procedures by the Sept. 30 deadline that Congress had set for spending the money. Unspent money will be returned to the federal government.

Deborah Oswalt, executive director of the foundation, said that starting the program this month is not feasible. "It's 90 days before the deadline," she said. "It really just doesn't provide sufficient time to do it, so we're just hoping the emergency TANF stimulus money gets extended."

Thomas Steinhauser, acting director of the division of benefit programs for the Virginia DSS, said the process took so long because the state had to review 13 proposals, including the foundation's, before forwarding them to federal officials.

"We had to clarify and make sure we understood what their proposal was and how we were going to fund it," Steinhauser said. He said the proposals were sent to HHS on March 1.

"My guess would be this was something new for HHS, too, and they were trying to work their way through the process." he said. "We were trying to figure out how to make it work in the state, and they were trying to make it work on the federal level."

An HHS spokesman said the department worked as quickly as it could.

Advocates say they hope Congress extends the Sept. 30 deadline. As with health care, the uninsured have few options for dental services. Virginia's 33 free clinics and community health centers that offer dental care provide basic services -- cleanings, fillings and tooth extractions -- but don't have the resources for reconstructive and restorative procedures, said Louis Markwith, executive director of the Virginia Association of Free Clinics. The emergency money would have helped pay for some of the more complicated procedures.

Additionally, some clinics see dental patients only one day a week and can sometimes fit in only a half-dozen patients a day. Many clinics are booked until next month.

Markwith said the clinics, which are run mainly by volunteers, can't meet all patient needs fast enough but might be able to with more staff and equipment. "We'll certainly try to respond if the funds become available," he said.

Coverage for adults

In the District, uninsured adults are covered for dental services through Medicaid and the D.C. Healthcare Alliance. In Maryland, some jurisdictions provide dental coverage to the uninsured, but Medicaid usually does not cover dental services for the state's adults.

In Virginia, the Medicaid dental safety net program covers low-income children but not adults, and jurisdictions are not required to provide services for the uninsured. Of 135 service areas in Virginia, 62 provide no access to dental services for the uninsured, Oswalt said.

Although many Americans take dental health for granted, it can be critical for people trying to get back on their feet or out of poverty. Advocates say that low-income Virginians' more serious dental needs keep them in pain, at risk for more serious health problems and possibly unemployed.

"Employers don't want to hire people with dental-care needs," said Elizabeth Lower-Basch, a senior policy analyst at CLASP, an organization focused on assisting low-income people through policy reform.

A social barrier

Willie Jackson, 56, who works at the Prince William County winter shelter, was once embarrassed by his deteriorating dental health. He said it limited the types of jobs he applied for, distracted him at work and kept him awake at night, nursing severe toothaches.

He spoke at a rally to galvanize state lawmakers to expand access to dental care and received a donation for a full pair of dentures.

Jackson paused during a dinner service recently at St. Paul United Methodist Church in Woodbridge to greet a volunteer with a white, and perfectly straight, smile.

"You feel like you're a whole person again, you know?" he said.

Gene Meier, a 47-year-old former appliance repair technician who was once homeless, obscures some of his discolored, chipped and missing teeth behind a graying mustache. He said the condition of his teeth has been one of the greatest barriers to finding a good job, even now that he is no longer homeless and lives in a supportive housing complex in Prince William.

"They're not gonna hire me because they figure I'm not gonna take care of myself," Meier said. "I have absolutely no income whatsoever and an obvious need for dental care. It's just so expensive."

Sen. Mark Warner (D-Va.) has written to HHS Secretary Kathleen Sebelius in support of the proposal, noting that inquiries for emergency dental care in Virginia have risen by 50 percent this year.

Although Oswalt and other advocates say they hope Congress extends the deadline, they recognize chances are slim. With a stagnant economy, looming deficit and high unemployment, dental care for the uninsured is probably low among lawmakers' priorities.

"It's not something that seems to be on anyone's radar right now," Oswalt said, adding that there is relatively little the foundation can do to push the issue through Congress. "We're supportive of the extension," she said, "but we're not lobbyists or anything."

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