Strengthen the dental safety net for all citizens

February 25, 2014 

Washington has one of the best children’s dental health safety nets in America – but dental care for vulnerable adults is lacking. It’s time to apply some of the lessons we learned in helping children to the system for adults.

How did our state build such a great system for children? It took long-term collaborative efforts among dentists, community health centers, nonprofits, state agencies and legislators. The state government has consistently allocated funding for the dental Medicaid program for children.

This focus and consistent funding resulted in Washington having the highest percentage of low-income young children receiving preventive dental care and the second lowest rate (15 percent) of third-grade students with untreated decay in the nation. And our system for children’s dental care keeps improving: More of Washington’s Medicaid-eligible children are going to a dentist than ever before.

When it comes to dental care for Medicaid-eligible adults, the picture is very different. For our state’s most vulnerable adults, the dental safety net has had a long history of cuts and reinstatements of benefits. For the past three years, most Medicaid-eligible adults have only had access to limited emergency care.

This policy is penny wise and pound foolish. A dollar spent on providing preventive care – for children or adults – saves many dollars needed later for treating dental disease. The emphasis on preventive and restorative care that is paramount to our children’s program is simply nonexistent when it comes to adults.

There is hopeful news when it comes to dental service for the underserved adults in our state. This year the state reinstated adult dental Medicaid benefits, and the federal government has dramatically expanded funding for the program. By restoring a comprehensive dental benefit for Washington’s existing Medicaid-eligible adults, the Legislature has allowed the state to also provide a comprehensive dental benefit for adults who are newly eligible for Medicaid under the federal Medicaid expansion. As a result, approximately 750,000 Washington adults are eligible for dental Medicaid.

Reinstatement of the dental Medicaid system for adults is a positive step, especially for community health centers and tribal clinics. Reimbursement rates for these clinics are much higher than the rates for private practitioners; they and allow them to treat both Medicaid-eligible and uninsured adults. These clinics are vital to the dental safety net, but they cannot carry the load on their own. We need the help of private practicing dentists.

Unfortunately, Washington has some of the lowest reimbursement rates in the nation for adult dental Medicaid patients seen in private practices.

Today, Washington dentists in private practice are reimbursed just 25 cents for every dollar spent treating adult Medicaid patients. Many private practitioners don’t even submit Medicaid claims because of a very convoluted and inefficient billing system that hardly justifies the effort for receiving a fee that doesn’t come close to covering the costs of providing the service. Pierce County dentists want to treat more eligible adults but cannot without higher reimbursement rates and a streamlined billing system.

Dentists in Pierce County and across the state are passionate about oral health and want to help achieve good oral health for everyone. In 2013, members of the Pierce County Dentists Care program donated $870,000 in dental care to more than 1,000 patients. This care was provided completely outside of the state Medicaid system.

Charitable care is an important component of the dental safety net, but charity is not a sustainable health care system. Additional financial support is needed to strengthen the dental safety net for all of our citizens.

We urge the Legislature to build upon our success with children’s dental Medicaid. We can use this successful program as a model to help our state’s most vulnerable adults. Consistent funding, higher reimbursement rates and improved billing provide us the opportunity to establish good oral health for all Washingtonians.

Dr. David Minahan is president of the Washington State Dental Association. Dr. Mark Kadoshima chairs the Pierce County Dental Society’s Access Committee.

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