BOSTON — Patients who have dental insurance through the state's Medicaid program are often faced with a difficult choice when they have a tooth that's badly decayed: They can pay out of pocket for a costly root canal, or have the tooth removed.

Budget cuts in the midst of a recession forced Beacon Hill leaders in 2010 to roll back adult coverage for most reconstructive dental procedures through MassHealth. Since then, its dental coverage has been mostly limited to routine cleanings and tooth extractions.

But lawmakers are proposing to reinstate coverage for root canals, crowns and other services as part of the latest version of the state budget.

A House version of the fiscal 2021 budget, debate on which got underway Tuesday, would authorize MassHealth to cover adult endodontic and prosthodontic services beginning next year. The House budget earmarks $19 million in the current fiscal year to pay for it.

Public health groups praise the move, saying it will improve oral hygiene, especially in low-income communities.

"These budget cuts were devastating for many Massachusetts residents, particularly those who were already underserved and facing multiple barriers to accessing timely and affordable dental care," said Dr. Neetu Singh, oral health director at the Boston-based nonprofit Healthcare For All.

In recent years, MassHealth has restored coverage for some adult dental services, such as fillings, full dentures and treatment of periodontal disease.

MaryJane Hanlon, president of the Massachusetts Dental Society, said those changes recognize the link between oral health and chronic, potentially fatal illnesses such as heart disease, hypertension and diabetes.

"This is a huge benefit that these patients have not been able to use for a long time," she said. "It's going to help both patients and providers."

How much expanding the coverage will ultimately cost isn't known. The proposal calls for a cost-benefit study of the expanded coverage. A report would be required to be submitted to the Legislature next March.

Lawmakers have wrestled with rising costs at MassHealth for years. The coronavirus pandemic has seen a steady rise in new enrollment in the government-backed health plans, driving up the state's costs.

Overall, the House budget plan calls for increasing MassHealth spending by $1.8 billion in the current fiscal year, to more than $18.5 billion.

It's not clear if the Senate's version of the budget, which is expected to be unveiled Thursday, will include the proposed changes to MassHealth coverage.

Democrats in the House and Senate have filed similar bills expanding the dental coverage, with both plans picking up a lot of support.

"We're obviously faced with a very difficult budget process right now," said Sen. Joan Lovely, D-Salem, who supports the changes to MassHealth's dental coverage. "But there are some things we can't say no to, and this is one of them."

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at cwade@cnhi.com

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