Oregon has some of the most generous health benefits for pregnant women, borne of the policy decision that ensuring a healthy start for new citizens will be one of the best investments steering a child toward a healthy, productive life.
Even before the Medicaid expansion, women up to 185 percent of poverty -- $21,800 for a single woman, or $44,900 for a family of four -- could get free health coverage while they’re pregnant. Immigrant women who are otherwise barred from receiving Medicaid can also get free care while pregnant to help with the healthy delivery of an Oregon child.
But despite advances in care through the coordinated care organizations, many of these women have no access to specialty dental care to fix a root canal or do reconstructive dentistry.
The House and Senate Health Committees heard a host of legislative bills aimed to approve the field of dentistry last week, but one of the most crucial bills seemed to be House Bill 3023, which would ensure that pregnant women can see a specialty dentist within 60 days of a referral.
Getting them the care they’re eligible for is tricky because these women are not covered by the CCOs or their dental care organizations. They are currently kept separate from the regular Oregon Health Plan because their eligibility is based on that short window of time that they are with child.
If they are citizens, caught in a window between 138 and 185 percent of poverty, these women continue to receive care for two more months before they must seek some other coverage, such as subsidized insurance on the federal exchange. Medicaid otherwise cuts off for them if they earn more than $33,500 for a family of four. If they are immigrant mothers of Oregon babies, their coverage shuts off the day their baby is born.
Lisa Bozzetti, the dental director of the Virginia Garcia Memorial Health Center, which cares for many migrant workers in Yamhill and Washington counties, said she had a patient who needed an emergency dental canal, but the clinic called all the local dentists and no one would take her till they found a dentist two counties away. Without transportation, the woman had no way to reach this dentist. “The tooth could not be saved,” she said.
Joanne Rogavoy of the March of Dimes testified that poor oral health during pregnancy can lead to poor nutrition and set back the child’s dental health once he or she is born.
“We consider oral care to be important from womb to tomb so we want to start this in pregnancy,” said Tony Finch of the Dental Health Coalition.
Mike Shirtcliff of Advantage Dental told The Lund Report that very few dentists will see non-CCO patients because they have no agreement with the state on payment, and the state has no leverage over them save their dental license.
Advantage sees 330,000 dental patients because it has forged agreements with managed care organizations, which continued with the CCOs. “The state was supposed to roll everyone into managed care because of the CCO model,” he said.
Because some of the women included in this program are not in the United States legally, it made it politically difficult to place them in the CCOs. Two years ago, the state expanded health coverage to cover all babies born into low-income households, even if the mothers have no legal paperwork to be in the United States.
Oregon was able to take advantage of a federal policy from the President Bush era that gives health benefits to a fetus from the time of conception, even if the mother is ineligible. Even legal immigrants are otherwise barred until they’ve been in America for five years. Bush favored the policy because of his anti-abortion politics, but immigrant women have been the ones to benefit.
“Politically, putting non-citizens into the CCOs is a touchy subject,” Shirtcliff said.
But Rep. Cedric Hayden, R-Cottage Grove, a dentist, seemed ready to move the pregnant women into the CCOs as a solution to the problem. “The CCOs have the networks. The open-card system does not have the network,” he said.
In addition to the usual health advocates in the Democratic caucus like Rep. Alissa Keny-Guyer, D-Portland and Sen. Elizabeth Steiner Hayward, D-Beaverton, three Republicans are currently listed as sponsors -- Rep. Knute Buehler of Bend, Rep Sherrie Sprenger of Stayton and Rep. Julie Parrish of West Linn.
Both Hayden and Shirtcliff didn’t see how the current bill could work, guaranteeing a speciality dental appointment within 60 days, without hooking the women up with some kind of managed care.
“There are enough providers. The barrier is fee-for-service -- they’re not in the CCOs. If they went into the CCO, or some other mechanism, the dentists would be there to take care of them,” Hayden said.