SoonerCare limits coverage for pulling teeth, genetic testing

Staff Writer mwingerter@oklahoman.com

Starting in October, adults covered by SoonerCare will only be able to get a tooth pulled if infection, injury or swelling create an emergency.

The Oklahoma Health Care Authority board voted to cover only “emergency” tooth extractions for adults covered by SoonerCare. Previously, the program covered “medically necessary” extractions.

The move will save the state about $479,017 — a relative drop in the $70 million budget hole the agency may need to fill after the Oklahoma Supreme Court struck down the cigarette tax in August.

Tywanda Cox, chief of federal and state policy at OHCA, said the change brings state policy in line with federal dental rules.

Starting Sunday, the state will only cover extractions necessary to relieve pain from an acute infection, swelling, injuries, or lockjaw, she said.

Courtney Barrett, who oversees OHCA’s dental program, said the agency considers medically necessary extractions to be the same as emergency ones, but there was some concern that providers interpreted it differently.

“The thought was that the previous language was looser, more open to interpretation, and potentially allowed for services that were not based on dental emergencies,” she said in an email.

Terrisa Singleton, director of the Delta Dental Oral Health Foundation, said relatively few adults in Oklahoma are eligible for tooth extractions through SoonerCare. Still, limiting those services could push SoonerCare recipients toward free dental clinics, which already are unable to serve all uninsured Oklahomans who need help, she said.

“Anything they take away is going to make this worse, and it’s already rough,” she said.

The board also voted to add more restrictions to screening adults to see if they carry the gene that causes cystic fibrosis. People who have one copy of the gene are usually healthy, but could have a child with the disease if their partner also carries a mutant copy of the same gene.

The change is expected to save the state about $255,000.

Newborns still will be screened as part of routine “blood spot” testing, and will receive followup screening if the blood spot test shows signs of a problem.

Cystic fibrosis causes thick mucus to build up in the body, damaging the lungs and digestive system.

It affects about one in 3,000 white newborns, but is less common in other ethnic groups, according to the National Library of Medicine.

In the past, almost everyone who had the disease died in childhood, but improved treatment has allowed more patients to survive into middle age.

The board also approved the following changes to save funds:

• Delaying care coordination fee payments to primary care providers until they see the patient whose care they will coordinate. Expected savings: $2 million.

• Processing the paperwork to end a member’s eligibility in 12 days, instead of at the end of the month. Expected savings: $539,000.

The thought was that the previous language was looser, more open to interpretation, and potentially allowed for services that were not based on dental emergencies.”

Courtney Barrett