CHAMPAIGN — Tooth pain drove Kyle Lomax to Urbana hospital emergency rooms twice.
Both times, Lomax — a 21-year-old Champaign man with two part-time jobs and no health insurance — left with pain medications and antibiotics, until he was able to get to a SmileHealthy mobile dental clinic to have the tooth pulled.
"I was in pain for a while," he recalls.
The mobile dental clinic serves mostly children, but once or twice monthly takes adults when sponsors cover the cost, says Nancy Greenwalt, executive director of SmileHealthy's parent organization, Promise Healthcare.
The rest of the month, adults in Lomax's situation try to get an appointment at the dental clinic her organization runs at 819 Bloomington Road, C.
But the clinic loses money and can't begin to keep up with the demand for new patient requests, Greenwalt says. There are hundreds of calls for the 16 new patient openings put up for grabs each Friday morning.
"On a typical Friday morning, we have three people on the phones and they can't get the calls fast enough," she said.
Promise Healthcare's dental clinic at the Frances Nelson Health Center opened in late 2011 with the help of a local United Way fund-raising effort to provide a "dental home" for uninsured patients and those in the state Medicaid program who can't get appointments at private dental offices.
But seven months after it opened, large-scale Medicaid benefits cuts went into effect under the state's SMART (Save Medicaid Access and Resources Together) Act, reducing dental benefits for adults on Medicaid to emergency extractions only.
Today, the demand for dental care for low-income adults is huge, Greenwalt says, but "there is almost no reimbursement."
Coverage isn't guaranteed for the newly insured signing up for Affordable Care Act coverage, either. Oral health for children is included in the 10 essential health benefits that must be provided by insurers selling health plans in the government marketplace, but oral health benefits for adults aren't required.
Adults getting covered by enrolling in the newly expanded Medicaid program will also be limited to emergency dental care, because it makes sense to keep benefits the same for everyone in the program, says Mike Claffey, a spokesman for the Illinois Department of Healthcare and Family Services.
For at least those marketplace health plans being sold, Illinois would have an opportunity to require insurers to offer oral health to adults as well as children if the state exits the current marketplace it runs in partnership with the federal government and starts running its own marketplace, says Campaign for Better Health Care Executive Director Jim Duffett. Legislation to pass a state-run health marketplace was approved last year by the Illinois Senate, but wasn't called for a vote in the House.
Greenwalt said adult patients in need of emergency dental care are generally worked in without much of a wait at her organization's dental clinic. But resources are limited for adding new patients because the clinic is striving to provide ongoing care to returning patients and several factors are keeping money tight.
Collecting reimbursement from the state for those emergency extractions for Medicaid patients is often a challenge, she says. The clinic's charges don't really cover costs, and many patients just can't pay.
The dental clinic loses "a ton of money," and gets by on community support and fund-raising, Greenwalt says.
"We've had really good community support," she adds. "I'm blown away. I'm touched at how the community supports this need."
The Illinois State Dental Society hopes to restore at least some additional benefits for adults in the Medicaid program through a pair of bills (HB4396 and SB2815) introduced in late January, said the organization's executive director, Greg Johnson. They would, in part, remove language in the state Public Aid Code that limits adult dental services to emergencies,
Meanwhile, he said, the organization plans to conduct another one of its "mission of mercy" events in June, in Peoria, in which its dentists will treat about 1,000 patients who need care in two days. And legislators will be invited to witness the demand.
"But charity is not a health care system," Johnson adds. "It's nice that we do these, but we can't get to every city every year and see thousands of people and fix things."
A $100,000 grant Promise Healthcare received recently from the Delta Dental Foundation will help expand care for children through the SmileHealthy program, and Greenwalt said she and the Promise Healthcare board are discussing the possibility of a part-time addition in dental staffing that could increase openings for adults.
But adding more patients means taking on more debt and fund-raising, she says.
Meanwhile, the DeWitt/Piatt Bi-County Health Department hopes eventually to reopen its own dental clinic, which it closed last May due to financial troubles.
"We cannot make ends meet as a Medicaid clinic," health department Administrator Dave Remmert said. "We started to accept other forms of dental insurance, but it was too late in the game to make a difference at that time."
That dental clinic opened to help low-income patients in dental pain who were turning to hospital emergency rooms, and it was constantly busy, Remmert said.
Most of those patients are now seeking care through other health department dental centers, he said, "but for them, it would be quite a drive."
A few services at the dental clinic at Frances Nelson Health Center, Champaign, and how fees are discounted for patients living at or below the federal poverty line.
— Limited emergency exam, X-ray and extraction: Full charge of $282 reduced to $60.
— Filling two cavities: Full charge of $330 reduced to $40.
— Comprehensive exam and X-rays: Full charge of $157 reduced to $40.
Note: 100 percent of federal poverty guidelines is an annual income of $11,670 for one person or $23,850 for a family of four.