Rhode Island Governor plans to cut dental services for 38,000 low-income residents

Rhode Island Gov. Don Carcieri (R) plans to eliminate dental coverage for an estimated 38,000 low-income parents enrolled in the RIte Care program by July 1, the Providence Journal reports.

According to the Journal, many advocates for low-income residents fear the move "could be the first of many cuts" as lawmakers make changes to the Medicaid program under the so-called "global Medicaid waiver" (Peoples, Providence Journal, 3/20). Under an agreement that Carcieri negotiated with CMS last year, the state will limit Medicaid spending to $12.4 billion through 2013. In exchange for capping spending, the state will receive broad authority to change services (Kaiser Daily Health Policy Report, 3/4).

The cut to dental services was introduced as part of Carcieri's 2009-2010 budget proposal. According to the governor's budget office, the cut would save Rhode Island $525,000, which would be used to help close the state's deficit of more than $860 million over the next two years. Amy Kempe, a spokesperson for the governor, said, "The state's budget deficit remains critical," and because of that the Rhode Island Department of Human Services "developed a budget initiative that achieved realistic savings and had minimal impact on service, access and outcomes."

Health care providers are concerned that cutting dental services could do "irreversible damage" to the state's dental system for low-income residents. According to the Rhode Island Health Center Association, health centers -- which "have generally become the dental providers of last resort" because most private dentists do not accept Medicaid -- served more than 31,000 adults in 2008, compared with fewer than 10,000 in 2003. Jane Hayward, CEO of the association and former Carcieri cabinet member, said, "Moving a number of people who have had coverage into an uninsured status will certainly change the financial basis for these centers to operate these services. Our fear is that it threatens not only our adults, but also some youngsters as well."

Rhode Island House Finance Committee Chair Steven Costantino (D) said that because the proposal is part of Carcieri's budget plan, it will be thoroughly vetted.

In related news, the Rhode Island General Assembly is still working on legislation to oversee the Medicaid overhaul. Costantino said, "If nothing passes right now, you've given the governor all the power in the world," adding that he is "sure" oversight legislation "will be resolved in time." Meanwhile, Carcieri is working on other Medicaid changes, according to the Journal. Ann Martino, policy administrator for the Department of Human Services, said, "Proposed rules and regulations will be ready for public comment during late April and early May" (Providence Journal, 3/20).