Patsy Brown dreams of apples, when the roots in her swollen gums relent her to slumber.
She thinks of how the skin breaks effortlessly when she puts her teeth to the fruit; of the crunchy burst of sweet and sour; the serrated mark of her first bite.
“I used to eat an apple every day,” the 49-year-old Yakima resident said.
Brown, a Medicaid recipient diagnosed bipolar and schizophrenic and who is unable to work, began losing her teeth a few years ago. All but five are broken off at the roots; only three of them remain whole.
Their swelling causes sharp pain, makes it difficult to eat, and sometimes renders her unable to move.
She will rest patiently on a floor mattress in her duplex on North Fourth Avenue in Yakima, which she shares with three other adult relatives and in-laws, as well as her three grandchildren. Housemate Renita “Ronnie” Kemp, Brown’s son-in-law’s mother, sometimes cuts up Brown’s food for her so she can delicately chew and swallow her meals.
“I have to gum it,” Brown said.
The state ended its basic dental coverage for Medicaid-eligible adults in January 2011; residents 20 and younger are still covered. Because of this, Brown says she goes to the emergency room when she is in the worst pain, only to be occasionally given antibiotics and a prescription for Ambien to help her sleep.
“It’s a hopeless feeling,” Brown said.
Proponents for restoring the coverage say the lack of preventive care for the uninsured has driven up costs for those who have coverage, and forced those without coverage to have their dental health deteriorate into even more costly situations. They say the hidden costs to taxpayers are folded into insurance rates as the uninsured seek routine dental help at emergency rooms.
“A lot of the things we see cut, the impact may not be apparent,” Lori Brown, director for Aging and Longterm Care of southeastern Washington, which is based in Yakima said. “The highest cost place you can get any care is the emergency room.”
Diane Oakes, spokeswoman for the Washington Dental Service Foundation, an oral-health advocacy group, said those who go to the emergency rooms don’t get the treatment or education they need to prevent their circumstances from deteriorating.
“Patients aren’t getting (Medicaid coverage) now unless it’s an extreme emergency situation,” Oakes said.
A 2011 report from the Washington State Hospital Association reported 2 percent of all unnecessary emergency room visits in 2008-09 dealt with dental issues, and two-thirds of those patients were Medicaid recipients or uninsured, which suggests an access problem for those populations even before the Medicaid adult dental benefit was cut in 2011.
“When you have folks come in who can’t pay for care, the care has to be paid for somehow,” Beth Zborowski, a spokeswoman for the Hospital Association, said. “That’s figured in when hospitals are contracting with private insurance companies.”
Oakes said there is a window of opportunity in the coming Medicaid expansion under the federal Affordable Care Act to bring basic dental care back. She said if the state puts forth a proposal to the federal government that includes dental coverage, there’s a chance federal money provided with the expansion could fill the void.
State officials, however, are more cautious in making that assessment.
MaryAnne Lindeblad, director of the state Health Care Authority, said it’s too early to tell if the restoration of adult dental care could be included in the expansion. Lindeblad said Washington was one of a few states to ever offer adult dental coverage for Medicaid recipients. Others don’t consider it important to overall health, which has since been scientifically challenged.
“As it related to Medicaid programs specifically, there are limited choices for what you can cut,” she said. “There are a limited array of services not mandated, and dental services is one of them.”
Until recently, Patsy Brown thought her pain would be something she lived with for the rest of her life. She said wherever she inquired about dental service, be it the emergency room or a local clinic, she was told there were no options; that she simply did not qualify under the system in place after the cuts in 2011.
Brown had no idea the state Health Care Authority retained funding for emergency dental services under Medicaid. Following an inquiry about her case from the Yakima Herald-Republic days before Christmas, Brown was contacted by the state and told she is eligibile for oral surgery.
“That was pretty good news,” Brown said.
Lindeblad said it’s unfortunate, but not uncommon, to see those in need go unaware of their range of medical options when other programs are cut.
“When people get a note of change, they may just assume there are no benefits,” she said. “I think that education piece has always been a challenge.”
Brown, who also suffers from short-term memory loss, cannot remember her Medicaid identification number, doesn’t have records of past services.
Interactions outside of her family are limited because she shies away from others.
“I don’t like leaving the house,” Brown said. “I’m a recluse.”
However, the Health Care Authority was able to use her name and date of birth to find her case and determine her eligibility. Last week, a spokesman for the Health Care Authority said they are now looking for an oral surgeon and, if need be, will pay for her transportation elsewhere in the state if one is not available locally.
“It would have been really unfortunate to see her go without this care,” Lindeblad said.
Brown’s in-law Kemp said it’s a relief for the rest of the family, which struggles to bring in income, to know she will finally get treated after more than a year of suffering.
“Nobody wants to see her in pain,” Kemp said. “It’s unfair that more people with dental problems can’t get help.”