Adhering to commitments to not give up hard-won gains in eligibility, most state Medicaid agencies have used other techniques, including reducing or freezing provider payments, eliminating certain benefits, instituting copayments, setting service limits such as total inpatient days or prescriptions covered, shrinking periods of guaranteed eligibility, and narrowing the time window for reapplying for coverage renewal.The reduced access to dental care is a critical one. Malcolm Gladwell touched on this awhile back in his New Yorker article on health insurance, but the bad effects of tooth decay, common among those who can't afford to see a dentist, start to multiply very quickly. First your teeth start turning brown and rotting, then you're pulling them out with pliers to stop the pain ("They'll break off after a while, and then you just grab a hold of them, and they work their way out"), then you can't eat fruits and vegetables, which invariably leads to further health problems, and then you can't ever land a job that requires you to be seen by other human beings—such as a bank teller, or a receptionist—since no employer will hire a receptionist with brown stumps in his or her mouth.
Medicaid payment reductions and freezes have exacerbated problems with access to key services such as mental health and dental care, as well as many types of specialty care. Applying copayments, eliminating benefits, and setting arbitrary limits on services is seen by some observers as "cost shirking," which leaves providers caring for these patients in the position of either dropping them or absorbing the cost of their uncompensated care. More commonly, providers avoid undertaking care for these patients to evade such discomforting situations.