Two health insurance companies plan to offer basic dental care coverage to adult Medicaid patients in Hawaii starting on Jan. 1.

The announcement Monday by AlohaCare and Ohana Health Plan addresses a void for adult dental care created when the state slashed funding for non-emergency adult Medicaid dental services in 2009.

The lack of state funding means that low-income adults have to pay out-of-pocket for cleanings, fillings and root canals, unless they are eligible for the state’s only free dental clinic for adults at Palama Settlement.

“We want people to be empowered to take care of their health,” says Laura Esslinger, chief executive officer of AlohaCare. “Right now they don’t even have coverage for basic cleanings.”

Data from the Hawaii Health Information Corp. shows a rising number of emergency room visits for dental problems in Hawaii. 

Esslinger says patients have the month of October to sign up for coverage through the state, and she encourages providers to join their network as well. The new dental coverage starts Jan. 1, 2019 and will immediately benefit 34,000 AlohaCare members who currently are not eligible for preventative dental care under Medicaid.

Both Esslinger and Scott Sivik, state president of Ohana Health Plan, said in phone calls Tuesday that the companies decided to offer dental services for Medicaid patients after reviewing the costs of emergency room services visits attributable to dental problems. The number of emergency room visits for oral health rose between 2007 and 2016 according to data from the Hawaii Health Information Corp.

As patients start to utilize dental benefits, Sivik says Ohana Health Plan will be watching to see if there are changes in overall health care costs or reductions in emergency room visits.

“Not all health care costs are bad,” Sivik says. The question is, “Is it the right care at the right time at the right cost?”

Like Sivik, Esslinger plans to collect data on how offering preventative dental services affects emergency room visits and health care outcomes.

“We hope that the data that we collect from trying this small benefit will help the state prove that its worthwhile to invest in dental in the future,” she says.

Kalihi resident Gertrude Aliado sits outside Kalihi Palama Health Center for dental services. Gertrude was waiting from 630am and the health center opened at at 8am.
Kalihi resident Gertrude Aliado arrived at the Kalihi Palama Clinic at get dental care after a week of pain. People often line up early in the morning to get dental services. Cory Lum/Civil Beat

Esslinger says the basic dental care benefits both companies are offering are limited compared to the comprehensive dental care coverage that Hawaii offered low-income adults prior to 2009.

“We’re really only taking a partial step,” she says, adding that AlohaCare continues to support reinstating state funding for non-emergency adult Medicaid dental care.

Although AlohaCare and Ohana Health Plan independently decided to offer these services, they announced the news together and will be providing the same menu of services: one annual exam; a cleaning every six months; fluoride treatment twice a year; one set of bitewing x-rays annually; and either a filling or a non-emergency extraction each year.

None of these basic services will require co-pays, but additional non-emergency dental care will need to be paid out-of-pocket.

“We believe that this is a very nice starting point package,” Sivik says.

Esslinger expects to see a corresponding decrease in emergency room visits for oral health but says it will take time to recoup those savings.

“For some people the emergency is too imminent,” she says. “That’s on us, as a society, that we didn’t cover it for 10 years.”

Sivik also says the cost of providing dental services won’t pay for itself in this year, but that it’s an “investment in doing the right thing.”

“It’s the right thing to do right now because we think there will be other benefits long-term,” he says.

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