Kids in need of emergency dental care stand a poor chance of getting it if they are covered by Medicaid, according to a new study published online in the journal Pediatrics.
Posing as mothers of a 10-year-old boy with a fractured front tooth, six research assistants phoned 85 dental practices in Cook County, Ill., twice, four weeks apart, requesting an appointment. Each time they told the same story, with one difference: health insurance. In one call, the boy was covered by Medicaid; in the other, Blue Cross.
In Illinois, even non-enrolled dentists can be reimbursed by Medicaid for providing emergency dental care. Still, the disparities in access were startling. While nearly all (95.4 percent) of kids with Blue Cross insurance got an appointment, only about a third (36.5 percent) of Medicaid-covered children did. Even among dental practices enrolled in Medicaid, children with Medicaid were still 18.2 times more likely to be denied an appointment than their counterparts with private insurance.
The study authors note that the scenario they came up with – of a boy with a fractured upper front tooth and pain after falling off a bike – was chosen by a pediatric primary care provider and dental consultants “as a common dental condition warranting timely treatment to optimize outcomes.” A crown fracture of a permanent front tooth – which the reported symptoms indicated – “requires urgent dental care, ideally within 24 hours,” the authors observe.
That nearly two-thirds of Medicaid kids in this situation were denied care is distressing. Another concerning finding: One-fifth of calls to Medicaid-enrolled practices on behalf of children covered by Medicaid resulted in appointments requiring cash payment – even though Illinois prohibits dentists from collecting cash for services rendered to Medicaid patients. Doing so is a violation of the dentist’s contract with the state dental administrator.
What’s clear here is that Medicaid coverage is no guarantee that a child with a dental emergency will get the care he needs.
So what’s the answer?
The study authors conclude: “Although removing provider barriers may not eliminate all oral health disparities, finding dental providers willing to accept public insurance and serve children from low-income families is arguably the first vital step toward improving the oral health of our nation’s children.”
Organized dentistry says the solution is to increase Medicaid reimbursement. Raising Medicaid rates for dentists can help, especially in states where payment rates are far too low. When paid appropriately for their services, dentists are more likely to accept Medicaid patients. However, higher reimbursement rates are not a fix-all. And, in the current economy, it is unlikely that states will raise their reimbursement rates.
We need to make it easier for dentists to treat more Medicaid enrollees. Interestingly, a 2010 report by the Pew Children’s Dental Care Campaign shows that, by bringing in new types of dental care providers – such as a dental therapist or a hygienist-therapist – most private dental practices could serve Medicaid patients without sacrificing their profits. In fact, according to Pew, solo private practices, where most dentists work, could even increase their profitability while expanding access to dental care.
In New Mexico, not only do we have a major shortage of dental care providers, but very few dentists treat significant numbers of Medicaid patients as part of their practice. Less than half our Medicaid-covered kids get any dental care at all in a given year. I hate to think what might happen to any of them in a dental emergency.
A dental therapist model could help solve this problem. Employed at half the cost of a dentist and able to provide some of the most commonly needed dental care services, dental therapists could make Medicaid financially feasible for many dental practices. Plus more kids would get the dental care they need.
That’s a win-win all around.
I welcome your thoughts.
This Los Angeles Times story provides some more background on the study. You can also read the study abstract on the Pediatrics web site.