Roughly $18 million that would restore basic dental benefits for hundreds of thousands of low-income Missouri adults is in limbo because of a sweeping budget action by Gov. Jay Nixon.
Acting under what he termed his constitutional duty to balance the state budget, Nixon late last month restricted or vetoed approximately $1.1 billion in spending for the fiscal year that began July 1.
Outside of education, the dental funds for adult Medicaid recipients make up one of the largest line items among the dozens included in the governor’s June 24 action. Cuts to mental health also axed an emergency services initiative in Kansas City, Mo.
“As much as we want to see this adult dental benefit in Medicaid happen,” says Gary Harbison, executive director of the Missouri Coalition for Oral Health, “we also recognize that there are serious concerns about the state budget as reflected in the action by the governor. So I think it is going to be awhile before we see something happen with this.”
Oral health advocates estimate the restored benefits, which were part of a larger package of Medicaid cuts enacted a decade ago, would extend services to about 300,000 able-bodied Missourians. Missouri Medicaid already provides dental services for special populations, including pregnant women, children, the blind and persons with disabilities.
The reinstated benefit would pay for services such as cleanings, fillings, X-rays and extractions.
Mental health cuts
Nixon’s budget moves also affected the Department of Mental Health, which would have to close six regional offices based on a veto of some of its funds.
Also included in the mental health cuts was $2.5 million earmarked for a pilot project in Kansas City to help address emergency psychiatric needs.
The idea of establishing a crisis stabilization center in the city is to make available a more appropriate setting for mental health emergencies than jails or emergency rooms.
A leading proponent of the effort is Kansas City Municipal Judge Joseph Locascio. Organizers were to meet Thursday for a day-long workshop to discuss the issue.
Locascio said he was disappointed – but not deterred – by the governor’s veto.
“This is not a defeat,” he said. “It is a delay. We are going to do this.”
The whole body
Medical experts, including professionals at the Mayo Clinic, argue that good oral health goes beyond caring for teeth and gums. Infections that start in the mouth can, among other things, cause heart problems, low-birth-weight babies and diabetes.
Oral health proponents also argue that preventative care reduces expensive trips to the emergency room for dental issues. Part of the money withheld by Nixon would fund four regional dental pilots aimed at diverting cases from the ER.
The Health Care Foundation of Greater Kansas City recently released a comprehensive oral health assessment of the services available to low-income populations in five area counties: Wyandotte and Johnson in Kansas and Cass, Jackson and Lafayette in Missouri.
Among the findings: The area has a sufficient number of dental providers, but not enough of them participate in the safety-net system, in part because Medicaid reimbursement is too low.
Using 2010 figures, the report says Missouri dentists recouped about 47 percent of their median retail fees when treating Medicaid patients, compared with 55 percent in Kansas and 60.5 percent nationally.
The funding withheld by Nixon would increase provider rates by about 50 percent in Missouri for specified services.
That could encourage more dentists to participate, says Patrick Baker, legislative and regulatory director for the Missouri Dental Association.
The increase, he says, would get fees “into a range where doctors are starting to break even.” Even reaching that point, he says, would likely require keeping costs down by seeing patients without staff on a nonbusiness day.
Missouri has a $26 billion budget, based on appropriations from last year.
In his veto message last month, Nixon said that several actions by the Republican-controlled General Assembly, including a number of tax breaks passed at the end of this year’s legislative session, had left the state with a budget that is “severely out of balance.”
Nixon also faulted the General Assembly for not expanding Medicaid eligibility, as authorized by the federal health reform law, to draw in federal dollars. And, he said, lawmakers compounded the budget problems by funding more than 30 new programs and the construction of a new state office building.
Republicans have countered that the tax measures were technical corrections to existing policies, and they blamed Nixon’s economic policies for the dip in state revenues.
Given that a significant amount of the disputed funding is slated for education, Republicans have also charged that Nixon is playing politics at the expense of students.
A similar fight last year ended with Nixon releasing about $400 million after the General Assembly failed to override his veto of an income tax bill.
State general revenue, made up primarily of personal income taxes, comprises about 70 percent of the total dollar amount that Nixon withheld or vetoed. Of the total covered by his actions, three quarters is eligible for release by the governor based upon state revenue collections in the coming months.
According to figures released last week by state Budget Director Linda Luebbering, net general revenue collections were down about 1 percent in fiscal 2014 from the previous year – decreasing from about $8.08 billion to $8 billion.
The revenue picture for the current fiscal year should become clearer by the fall, says Jay Hardenbrook, director of public policy for the Missouri Budget Project. One component of that, he says, is whether the General Assembly overrides Nixon’s veto of the tax law changes lawmakers made at the end of the last session.
The veto session begins Sept. 10.
It is not unusual to have end-of-year financial adjustments by governors, says former Missouri Rep. Jeanette Mott Oxford, now executive director of the Missouri Association for Social Welfare. It happened frequently during her eight years in the General Assembly, she says.
But she does not recall the total amount going beyond millions.
“I don’t remember having the ‘b word’ connected to it,” she says of the billion dollar total. “That is a significant bit of money.”
Mike Sherry is a health reporter for the Hale Center for Journalism at KCPT.