By Jordan Shapiro

Dr. Heidi Miller still remembers the time a young patient came to her office a few years ago complaining about head pain. The patient had an abscess _ a swollen area of body tissue _ on his face, a complication of poor oral health.

"It was so big that it looked like his face was stretched as big as a baseball," said Miller, who works at Family Care Health Centers. "It's very disheartening because it is totally preventable."

Miller and other health workers are hopeful that such cases will soon become more rare. Starting in the fall, about 250,000 low-income Missourians may have access to dental care for the first time in a decade.

Missouri's Medicaid program, which provides government-funded health insurance to low-income residents, now only reimburses dental services for recipients who are children, pregnant, blind or live in nursing homes.

Other adult recipients received dental services up until 2005 when they were ended as part of a larger round of Medicaid cuts by Gov. Matt Blunt. Now those beneficiaries are set to again get dental care. About $14 million in money for dental services was included in the state budget for the fiscal year that begins July 1.

Community health organizations and advocates had pushed for years to restore the dental benefits. They argued about the importance of oral health to a patient's overall well-being and the costly implications of unchecked dental issues.

"Access to adult dental services that are reimbursed through Medicaid is incredibly important," said Alan Freeman, CEO of Affinia Healthcare, formerly Grace Hill Health Centers.

Freeman is also a former director of the Missouri Department of Social Services, which oversees the Medicaid program. Freeman said the state budget plan means providers like his center can be reimbursed for about 45 dental procedures, including tooth extractions, exam visits and imaging.

"The timing couldn't be better to restore these benefits," said Joseph Pierle, executive director of the Missouri Primary Care Association, which represents community health centers.

Pierle was, in part, referring to the launch of a new dental clinic in St. Louis next month. The $25 million, 79,000-square-foot facility will open near Lafayette Square and is a partnership between A.T. Still University and Affinia Healthcare.

The clinic is part of a program between the university and the Missouri Primary Care Association to train more dentists. Pierle said without Medicaid funding for adult dental services there was concern not enough students would remain in the program or stay in Missouri after graduation.

But it could still be a few months before Medicaid recipients actually receive care.

State officials say funding for the program won't be available until at least September, if not a few months later. That's because the state budget plan pays for the dental benefits with revenue for a one-time grace period for delinquent taxpayers, which doesn't start until the fall.

It's also possible the money may not be there at all. Missouri Gov. Jay Nixon withheld money for dental services last year, citing concerns about anemic state revenue. Nixon has the power to block the funding again this year but has not indicated any plans to do so.

In an emailed statement, Nixon's office pointed out that funding for dental services won't be available until the fall and the governor's commitment to a "more efficient and effective approach" to expanding Medicaid coverage, a reference to his push to add 300,000 Missourians under the federal health care law.

A 2014 report by the Missouri health department estimated there are 60,000 emergency department visits because of nontraumatic dental problems that cost about $17.5 million per year. The report also said hospitalizations because of such issues are associated with about $13.5 million in hospital charges annually.

Highlights of Dental Expansion

_About 250,000 Missouri adults could qualify for dental benefits starting in the fall.

_The services are expected to cost the state about $14 million for one year. It is projected to start sometime this fall.

_Benefits include tooth extractions, exams and imaging.

_There are about 600,000 emergency room visits every year for non-traumatic dental problems.

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