New effort to help low-income adults get dental care in Whatcom County

THE BELLINGHAM HERALDMarch 14, 2014 

A new $164,175 grant will be used to help low-income adults in Whatcom County get dental care - a service many have long said they need most but are least able to access.

Whatcom Alliance for Health Advancement, which received the grant, will lead the effort to help the 22,500 Whatcom County adults who became eligible for adult dental care through Medicaid as of Jan. 1.

That's because Washington state legislators decided to expand Medicaid as part of federal health care reform and to reinstate adult dental coverage.

(In 2011, the state's Medicaid program stopped paying for non-emergency dental care for most adults to help balance the state budget. But poor adults had struggled to get care even before that, according to survey results like the 2006 and 2011 Whatcom Prosperity Project.)

Those changes made dental coverage available to about 15,000 existing Medicaid recipients in the county and an additional 7,500 adults who were newly eligible for Medicaid as of the start of this year, according to the Whatcom Alliance for Health Advancement.

"We knew there was going to be this massive demand," said Lara Welker, program manager for the nonprofit WAHA.

The nature of the care they need also presents a challenge. Because many haven't seen a dentist for a long time, it takes longer to clean their teeth or do restorative work like filling cavities.

"On the front end there's this huge backlog of need," said Desmond Skubi, executive director for Interfaith Community Health Center. "It is a huge undertaking to make this new benefit a reality on the ground."

So being eligible for dental care doesn't necessarily mean being able to get that care.

"Health insurance doesn't always equal health care. Access is way more than being insured," Welker acknowledged.

To help, WAHA asked the Washington Dental Service Foundation for the two-year grant.

"I think the starting point is to understand what the maximum potential is for the current system up there," said Diane Oakes, deputy director for the foundation.

WAHA plans to use the grant for what it calls "Bridging the Gap - Coverage to Care." Those efforts include:

-- Studying the current capacity of community clinics and dentists in private practice to provide care, and then trying to increase that.

The goal is to quantify what advocates have known anecdotally - there aren't many dentists in Whatcom County who accept adults with Medicaid as clients - and to better understand why that is.

"I don't think we're having a dentist shortage in Whatcom County," said Welker, who also heads up the Whatcom County Oral Health Coalition.

Reasons could include low Medicaid reimbursement rates for dentists in private practice, a cumbersome billing system for Medicaid, few openings in nearly maxed-out community clinics like Interfaith and Sea Mar Community Health Centers, and concern among private dentists that they will be inundated by requests if they try to accept just a few Medicaid clients, according to advocates.

-- Developing a coordinated intake and referral system to screen WAHA clients and connecting patients with the most urgent dental needs to care.

-- For the short term, creating a referral service through WAHA for dentists in private practice who want to provide care for Medicaid clients. The nonprofit already has experience doing this through its Whatcom Project Access Dental, a program it created after the 2011 Medicaid cuts to connect low-income clients to dentists who volunteered their services.

"The concept is that controlling the flow of Medicaid patients will make it more feasible for dentists to accept them, with each practice deciding how many referrals it can take," Welker explained.

"It's based on the premise that dentists do want to help with addressing the access problem, and would utilize a system/structure that makes that possible," she added.

Creating such a referral system will take time and it likely will expand slowly, Welker said, adding the service would be only a partial solution.

-- Work with others in the community to develop long-term solutions so adults on Medicaid can get dental care.

That could include expanding community health centers so they can accept more adults. (For its part, Skubi said Interfaith is adding two dentists and planning for a new dental clinic.)

Other possibilities include getting more dentists in private practice to accept Medicaid clients possibly through changing the Medicaid system itself, and/or creating other clinic models.

-- Work with medical providers to assess risk and screen for oral health problems and refer to dentists when needed. The idea is to catch oral health problems and to link oral health to overall health.

Reach Kie Relyea at 360-715-2234 or kie.relyea@bellinghamherald.com .

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