SPRINGFIELD, Ill. -- Beginning today, indigent adults in Illinois no longer will be covered for dental, chiropractic, optometric, podiatric and hospice care under Medicaid.

The change, which affects only people 21 and older, is part of the legislature's attempt to reduce by $300 million the state's $1.3 billion Medicaid deficit.

The cuts amount to about $25 million of the total reduction, which is to be achieved through paring a variety of programs.

The state's cuts come in areas where federal matching funds aren't available, as they are for standard medical care.

"We were above and beyond what the federal government was calling for," said David Spinner of the Department of Public Aid in Springfield.

All indigent adults, including the elderly and physically or mentally disabled, will be affected by the cuts.

Fred Bernstein, executive director of the not-for-profit Community Health Center in Cairo, says the savings may be outstripped by the ultimate price of forcing poor people to seek out more costly care or go without care.

As an example, indigent people who need emergency dental treatment logically now will seek help in hospital emergency rooms, where the state will end up paying a physician to dispense treatment in the form of a painkiller.

"We would be paying for a service that didn't provide a cure," Bernstein says.

Not covering the most common emergency dental procedure -- extractions -- doesn't make sense, he said.

Community Health and Emergency Services Inc. operates a full-service clinic in Cairo and a satellite clinic in Tamms, employing about 80 people. Both are federally qualified health care centers, which means they must see everyone who comes into the facility whether the person can afford to pay or not.

In return, the clinic receives a grant from the federal government based on projections of its client base.

The Cairo clinic offers medical and dental care, lab and X-ray services, emergency care and ambulatory surgical care.

It serves Alexander and Pulaski counties, but sees patients from all over Southern Illinois because it is one of the area's few dental operations that accepts Medicaid.

To qualify for Medicaid in Illinois, a single person cannot earn more than $1,413 per month. The amount increases for families. Those who qualify pay for treatment on a sliding scale.

Bernstein said the majority of the people who come to the clinic on Medicaid are female heads of households. "Most of the mothers in question probably are not going to put their needs first," he said.

He estimated that 200 of the clinic's patients will be affected immediately.

"It's not too difficult to see that by being forced to find means to pay for those services or failure to treat, which can lead to greater health problems, it's going to impact that population severely," said Bernstein, who has directed the clinic for 10 years.

The IDPA opposed these Medicaid cuts, according to Spinner, coordinator of the department's Federal Qualified Health Centers Program.

"We wanted to keep the status quo for humanitarian reasons," he said.

Spinner said some clinics in Chicago are going ahead and treating Medicaid dental patients using the same sliding scale. "They're going to eat most of that cost," he said.

Spinner hasn't heard much from the clinics affected because dental and the other procedures don't account for that much of their income.

Bernstein said his clinic now will concentrate on preventive dentistry for children. "We think we'll be pretty busy anyway," he said.