There’s little dispute that it’s gotten significantly easier for poor children in Connecticut to see a dentist since 2008, the year the state settled a longstanding class-action lawsuit over access to dental care.

The number of dental providers participating in Medicaid has more than quadrupled since then, and the number of patients under 21 receiving dental services under Medicaid grew by nearly 50 percent from 2009 to 2012, according to a report released this week by the Connecticut State Dental Association.

But the 2008 settlement expired last summer. And that means that the increased Medicaid fees for dentists included in the agreement are no longer protected from the state’s budget woes.

“The state is under a lot of pressure in terms of budgeting, and we really don’t know what’s going to happen,” said Dr. Carolyn Malon, a Farmington dentist and president of the state dental association. “One would hope that we would be able to convince the governor and the legislature to continue to fund at least at the same rates that they have over the last few years, but we really don’t know.”

Cutting dental provider rates were not included in the list of budget options the Department of Social Services prepared for the upcoming two-year budget period.

As part of the 2008 settlement, dental services were “carved out” of the Medicaid program, handled separately from the three managed care companies that administered the program at the time. Malon said the procedures for getting paid for seeing Medicaid patients were streamlined, eliminating stumbling blocks providers faced in participating in the program.

There’s also been a major effort by DSS, advocates and the dental association to increase Medicaid participation, and to educate people about the importance of oral health care.

The efforts “paid off tremendously,” the report said. The number of dental providers in the Connecticut Dental Health Partnership — the Medicaid dental program — rose from 376 in 2008 to 1,567 in 2012. More than 90 percent of Medicaid providers are accepting new patients.

The number of clients under 21 getting dental services covered by Medicaid rose from 139,000 in 2009 to more than 207,000 in 2012, according to the report, while the number of adults over 21 getting services in that time rose from 105,000 to 150,000.

The fees paid to dentists for treating adults in Medicaid remain far below the fees for treating children, and many dentists lose money treating adults, Malon said. But the dental health partnership has worked to improve access to care for both adults and children, and Malon said the dental association has encouraged members to treat the parents of any children they see, to emphasize the importance of lifelong dental care.

More people are receiving preventive services, while the number of restorative procedures is “beginning to stabilize” and is expected to decline in the future, according to the report.

“Connecticut is a national model in how it provides services to children enrolled in Medicaid,” the report said.

Another report on the dental program, released by Connecticut Voices for Children in 2011, also documented improved access to services and use of care by children in Medicaid.

Malon said dentists are hopeful the increased Medicaid rates will survive the upcoming budget process. She said Gov. Dannel P. Malloy has been “very supportive of dentistry, dental care and oral health care in the past.”

The governor and legislators did cut adult dental benefits in Medicaid, allowing only one visit per year instead of two, but even so Connecticut’s Medicaid dental coverage is still better than that in most other states, Malon said.

“In so many states they’ve eliminated it completely,” she said. “So we weren’t happy about it, but we accepted that at least he is understanding that it is important.”

Arielle Levin Becker covered health care for The Connecticut Mirror. She previously worked for The Hartford Courant, most recently as its health reporter, and has also covered small towns, courts and education in Connecticut and New Jersey. She was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on caregivers from the National Association of Health Journalists. She is a 2004 graduate of Yale University.

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