BILL ANALYSIS �
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THIRD READING
Bill No: AJR 30
Author: Pan (D), et al.
Amended: 4/9/12 in Assembly
Vote: 21
SENATE HEALTH COMMITTEE : 6-2, 6/6/12
AYES: Hernandez, Alquist, De Le�n, DeSaulnier, Rubio, Wolk
NOES: Harman, Anderson
NO VOTE RECORDED: Blakeslee
ASSEMBLY FLOOR : 51-25, 4/9/12 - See last page for vote
SUBJECT : Medicare: dental care
SOURCE : California Senior Legislature
DIGEST : This resolution memorializes the President and
Congress to enact appropriate legislation that would add
comprehensive, preventative dental care coverage to
Medicare benefits.
ANALYSIS :
Existing federal law:
1. Establishes the Medicare program to provide various
medical services to adults ages 65 and older,
individuals under age 65 with disabilities, and
individuals with end-stage renal disease.
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2. Prohibits payments from being be made under Medicare
Part A (hospital services) or Medicare Part B (physician
services) for any expenses incurred for specified items
or services. Excluded items include expenses for
services in connection with the care, treatment,
filling, removal, or replacement of teeth or structures
directly supporting teeth.
3. Permits payments under Part A in the case of inpatient
hospital services in connection with the provision of
dental services if the individual, because of his
underlying medical condition and clinical status or
because of the severity of the dental procedure,
requires hospitalization in connection with the
provision of such services.
This resolution:
1. Memorializes the President and Congress to enact
appropriate legislation that would add comprehensive,
preventative dental care coverage to Medicare benefits.
2. Makes various finding regarding dental care for
individuals ages 65 and older, including the following:
A. National Health Interview (NHI) surveys from 1997
to 2009 found 24 to 30% of persons 65 years of age
and older were edentulous (without teeth);
B. NHI surveys also found that during that period
only 17 to 24% of older edentate persons, compared to
69 to 73% of older dentate persons, had a dental
visit in the past year;
C. Medicare does not currently provide for most
dental care;
D. Senior citizens often cannot afford the
out-of-pocket costs of dental care;
E. A study done in March 2005 by the State University
of New York, University at Buffalo's School of Dental
Medicine found that cost was a major factor in senior
citizens not obtaining dental care;
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F. Covering medical illnesses that are directly
correlated with poor dental health can be a
significant expense for Medicare;
G. Many of the diseases correlated with dental health
are preventable and could be avoided or mitigated
through better dental care; and
H. Including dental coverage in Medicare benefits
will lower the program's medical expenses as well as
improve the quality of life of senior citizens.
Background
Medicare and dental coverage . According to the Centers for
Medicare and Medicaid Services (CMS), which administers the
Medicare program, the dental exclusion from Medicare
coverage was established as part of the initial program.
In establishing this exclusion, Congress did not limit the
exclusion to routine dental services but instead included a
blanket exclusion of dental services. CMS states Congress
has not amended the dental exclusion since 1980, when it
made an exception for inpatient hospital services when the
dental procedure itself made hospitalization necessary.
CMS states Medicare will currently pay for dental services
that are an integral part either of a covered procedure
(e.g., reconstruction of the jaw following accidental
injury), or for extractions done in preparation for
radiation treatment for neoplastic diseases involving the
jaw. Medicare will pay for oral examinations, but not
treatment, preceding kidney transplantation or heart valve
replacement, under certain circumstances. Such examinations
would be covered under Part A if performed by a dentist on
the hospital's staff, or under Part B if performed by a
physician. Some Medicare Advantage plans cover dental
services voluntary.
Prior legislation . AB 5X4 (Evans), Chapter 20, Statutes of
2009, eliminated Medi-Cal coverage of a number of Medi-Cal
benefits that are optional for states to provide under
federal law, effective July 1, 2009, to achieve budget
savings. One of the optional benefits eliminated from
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Medi-Cal coverage was adult dental services. Following the
enactment of AB 5X4, only the following persons continue to
receive dental services through Medi-Cal:
1. Pregnant women, if it is part of their pregnancy-related
care or for services to treat a condition that may cause
problems in pregnancy.
2. Children or young adults who are 20 years old and
younger and receive full-scope Medi-Cal.
3. People who live in a licensed nursing home such as a
Skilled Nursing Facility, Intermediate Care Facility
(ICF), ICF for the Developmentally Disabled and
Sub-Acute Facility.
4. People needing dental treatment that can be provided by
a physician.
FISCAL EFFECT : Fiscal Com.: No
SUPPORT : (Verified 6/6/12)
California Senior Legislature (source)
AFSCME, AFL-CIO
Health Access California
ARGUMENTS IN SUPPORT : This resolution is sponsored by
the California Senior Legislature, which states that a
major factor in senior citizens not obtaining dental care
is financial and, even if cost is not an issue, about 30%
of older adults face difficulties in getting to a dental
office because they may be frail, homebound, or live in
nursing homes. The sponsor maintains that it would be a
worthwhile investment for Medicare to include dental
coverage because many of the diseases associated with poor
dental health in older adults are preventable and could be
avoided or mitigated through access to routine dental care.
Health Access California writes in support that Medicare,
which keeps seniors healthy across the country, could
remove cost as a significant barrier to seniors seeking
dental care by including dental care as part of its benefit
package.
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ASSEMBLY FLOOR : 51-25, 4/9/12
AYES: Alejo, Allen, Ammiano, Atkins, Beall, Block,
Blumenfield, Bonilla, Bradford, Brownley, Buchanan,
Butler, Campos, Carter, Chesbro, Davis, Dickinson, Eng,
Feuer, Fletcher, Fong, Fuentes, Furutani, Galgiani,
Gatto, Gordon, Hall, Hayashi, Roger Hern�ndez, Hill,
Huber, Hueso, Huffman, Lara, Bonnie Lowenthal, Ma,
Mendoza, Mitchell, Monning, Pan, Perea, V. Manuel P�rez,
Portantino, Skinner, Solorio, Swanson, Torres,
Wieckowski, Williams, Yamada, John A. P�rez
NOES: Achadjian, Bill Berryhill, Conway, Donnelly, Beth
Gaines, Garrick, Gorell, Grove, Hagman, Halderman,
Harkey, Jeffries, Jones, Knight, Logue, Mansoor, Morrell,
Nestande, Nielsen, Norby, Olsen, Silva, Smyth, Valadao,
Wagner
NO VOTE RECORDED: Charles Calderon, Cedillo, Cook, Miller
CTW:k 6/6/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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