Marcia Esters needs crowns fused to six of her bottom teeth and new dentures, but because of changes made to Medicaid in Pennsylvania, she now has to pay for it all herself.
"It's thousands of dollars' worth of work that I cannot afford," she says. "I have one income and my family is poor."
Esters also needs a wheelchair, and now that she can't get her teeth fixed, she has spent the last few months eating pureed food and isolating herself.
"I don't go anywhere unless I have to. I mean people look at you when you’re in a wheelchair or you have the kind of assistance I have. If you could look or feel halfway decent, it just helps, it really does."
Medicaid, a program funded jointly by the federal government and the states, covers the the poor and disabled, and coverage varies by state. Most states don't pay for any dental care. Now, in Pennsylvania, Republican Gov. Tom Corbett has reduced Pennsylvania's 2 million adult Medicaid patients to basic dental care – eliminating root canals, periodontal disease work and limiting the number of dentures a patient can receive. The plan now covers little more than cleanings, fillings -- and extractions.
The Pennsylvania Department of Public Welfare estimates it is saving $42 million this year. Spokesperson Anne Bale explains they needed to save this money.
"We can't keep up with the spending that is going on. So we have to limit the number of procedures people have so we can insure the program for the future."
This frustrates dentists like Adam Mychak. He sees about 2,000 Medicaid patients a year at his practice in Pittsburgh.
"The only thing we can do for someone who comes in is put a filling on that tooth when it has decay and when that tooth starts to hurt. Eventually that filling gets bigger and bigger over time the only thing we can do then is take the tooth out," he says.
The state allows petitioning for additional funds, but since last fall the state has received more than 7,500 appeals, and most were denied – including one filed by Marcia Esters.
Surveys show people with disabilities have a harder time seeing a dentist than any other group. Part of the problem is cost: Many dentists don’t take Medicaid since it doesn’t bring in a lot of money.
And there are other issues. A dentist's office may not be able to accommodate someone in a wheelchair. Patients with behavioral issues may require sedation that only an anesthesiologist can provide.
Lynne Taiclet, who runs the Center for Patients with Special Needs at the University of Pittsburgh’s Dental School, says these are actually relatively new problems for dentists.
"Patients that live in group homes and in their families' homes now didn't do that 40 and 50 years ago. They were institutionalized at a young age, and the institutional setting took care of their medicine, their dentistry, all of it."
Marcia Esters is hoping that a charity will help with her dental expenses or else she’ll have to have her remaining bottom teeth removed. She is already struggling with digestive issues and depression – but treatment for those is covered.
This story is part of a reporting partnership that includes Essential Public Radio, NPR and Kaiser Health News.