PROVIDENCE –– Two months have passed since Governor Carcieri won unprecedented authority to overhaul Rhode Island’s massive subsidized health care system.

But just one specific proposal has emerged in that time. And despite promises to expand health care choices, that proposal would cut services for tens of thousands of low-income adults.

Specifically, the governor plans to eliminate dental coverage for an estimated 38,000 parents enrolled in the RIte Care program as of July 1. Children, those under 21 and pregnant women are among those spared from the cost-cutting maneuver, which must survive legislative scrutiny before becoming final.

“The state’s budget deficit remains critical,” the governor’s spokeswoman, Amy Kempe, said. “As a result, [the Department of Human Services] developed a budget initiative that achieved realistic savings and had minimal impact on service, access, quality and outcomes.”

The plan, submitted as part of Carcieri’s 2009-10 budget, would save taxpayers $525,000, according to the governor’s budget office, which is charged with closing deficits exceeding $860 million over two years.

Advocates for the poor fear the proposal could be the first of many cuts under a Medicaid redesign, dubbed the “global Medicaid waiver,” that the governor said would save money and improve Rhode Island’s health care system over the next five years. In promoting the waiver, Carcieri largely focused on plans to help seniors stay out of nursing homes. But he also has new authority to make expedited changes to programs that affect thousands of low-income children, adults and disabled residents.

And the General Assembly, despite public pledges to adopt strict oversight legislation, has yet to approve a bill because of differences between the House and Senate.

“We have no agreement on it,” House Finance Committee Chairman Steven M. Costantino said earlier in the week after the Senate passed a version of the oversight bill. “If nothing passes right now, you’ve given the governor all the power in the world.”

Meanwhile, health care providers fear that cutting dental services for thousands of Rhode Islanders could do irreversible damage to the dental system recently designed to care for the poor.

Because most private dentists do not accept Medicaid, health centers have generally become the dental providers of last resort.

Responding to a growing need, the centers served more than 31,000 adults last year compared with fewer than 10,000 in 2003, according to information provided by the Rhode Island Health Center Association.

The association president and CEO, Jane Hayward, a former Carcieri cabinet member, fears the governor’s proposal could indirectly jeopardize dental services for children, who might lose access to their only source of dental care.

“I think that we’re very concerned about it,” Hayward said. “Moving a number of people who have had coverage into an uninsured status will certainly change the financial basis for these centers to operate these services. Our fear is that it threatens not only our adults, but also some youngsters as well.”

After 20 years in private dental practice and 8 with a North Kingstown health center, Dr. Robert Grace says the governor’s plan would almost certainly cause a negative ripple effect throughout Rhode Island’s health care system.

“If we lose adult dental services, we are in danger of closing … That means all the advances we’ve made in community health clinics over the past 10 years, we start to see that reversed,” Grace said. “But more important than me losing my job is the number of patients in the state who will lose access to dentists.”

And the governor’s numbers don’t make sense either, Grace says.

Carcieri plans to cut dental, but not medical coverage. That means those with severe dental problems would simply turn to emergency rooms, he says, which are basically limited to prescribing medication.

“We’re going to lose the savings to the emergency rooms and the patients will not be any better off,” Grace said. “They will be worse off.”

Most states provide coverage to adults on Medicaid, according to the National Academy for State Health Policy.

As of early 2008, 45 states, including the District of Columbia, provided “some type of coverage of dental benefits to at least some Medicaid-enrolled adults,” although those services vary greatly and sometimes include “emergency-only” coverage, according to a report issued last year.

Costantino said there would be thorough vetting of Carcieri’s plan because it was introduced as part of his 2009-10 budget. Asked when the oversight legislation would become law, he said, “I’m sure it will be resolved in time.”

Meanwhile, the Carcieri administration has been busy behind the scenes pursuing other Medicaid changes.

“Proposed rules and regulations will be ready for public comment during late April and early May,” said Ann M. Martino, policy administrator for the Department of Human Services. “The vast majority of the work under way in these areas is highly technical and, though not immediately visible, proceeding apace … In short, there’s lots happening.”

speoples@projo.com