Almost half-a-million Coloradans are expected to gain dental benefits under Medicaid by 2016. That doesn’t mean they’ll be able to see a dentist.
Two state policy changes rolling out next year are intended to improve access to oral health care for low-income Coloradans. The state Legislature earlier this year voted to expand Medicaid’s dental benefits to adults – it now only covers children for most kinds of care.
The change will go into effect around the same time as Colorado expands Medicaid coverage under the Affordable Care Act to those who make slightly more than the federal poverty level.
The pair of changes is expected to grow the ranks of Medicaid enrollees with dental benefits to 844,491 in 2016, from 348,142 last year, according to a study released last week by the Colorado Health Institute.
But 17 counties in Colorado don’t have a dentist who accepts Medicaid, the study reported.
Some rural areas simply don’t have dentists at all – you won’t find one in sparsely populated Kiowa County in the eastern plains or in southern Colorado’s Mineral County, the institute found. In more populous Delta and Elbert counties, there are dentists – but none who take Medicaid.
In La Plata County, the number of Medicaid enrollees with dental benefits is expected to rise from 2,556 in 2012 to 7,373 by 2016, which is 14 percent of the county’s population. In La Plata, six of 31 dental practices accept Medicaid patients.
Chaffee County ranks among the areas with a low percentage of dentists accepting Medicaid. Cara Russell heads the county’s program to improve oral health, which works to educate people about the importance of good oral hygiene.
Preventive dental care can keep people from showing up in pain at emergency rooms and in need of expensive surgery. Poor oral health also is associated with chronic diseases such as diabetes and heart disease, according to recent studies cited by the U.S. Centers for Disease Control and Prevention.
But inspiring someone to go to the dentist doesn’t get them there, Russell says. For those living in her area of the state, the nearest dentist accepting Medicaid often is a drive of 65 to 110 miles. At the same time, much of the working population will remain uninsured even as Medicaid expands.
“We are on the verge of much better care for our underserved population,” Russell said. “But we’re not there yet, and the transition is going to be painful.”
In the southeastern Colorado town of Walsh, Carol Morrow is the only dentist in Baca County, population 4,500. She accepts Medicaid, making her office an oasis in a dental desert. Some patients drive hours to get to her.
“I think every person deserves the same kind of care, whether they can afford it or not,” Morrow said. The expansion of Medicaid benefits to adults will allow her to get some compensation for care she now provides for free, she said.
Morrow is participating in a new push by the Colorado Dental Association to encourage more dentists to accept Medicaid as the policy changes unfold.
The professional group is fighting a perception among some dentists that the paperwork is too cumbersome and reimbursement rates too low and an unfounded fear that Medicaid patients will fail to show up for appointments, says Jennifer Goodrum, who directs the organization’s government relations.
Jeff Hurst, who runs a practice in Lakewood, is one of the Colorado dentists who doesn’t take Medicaid. The 40-page application form to become a Medicaid doctor is one barrier. Payment is another reason Hurst stopped seeing Medicaid enrollees. The state is slow to process claims, and the reimbursement doesn’t even cover his office’s overhead costs, he said.
However, Hurst is heartened by recent moves by state officials to make it easier to navigate the application and payment process and raise reimbursement rates.
“Removing these barriers will allow us to treat these patients the same way we treat others,” Hurst said. “These adults – some of whom have never had care – can get introduced to the world of dentistry.”
Still, improving access to dental care is likely to take creative thinking in places as far-flung as Delta County on the Western Slope, Conejos County to the south, and a huge swath of the eastern plains, where Medicaid enrollees far outnumber dentists willing or able to provide services.
Expanding the role of dental hygienists may be one solution, while boosting the capacity of dentists who already see low-income patients may be another route.
“Communities are gearing up and getting ready,” said Sara Schmitt, one of the authors of the Colorado Health Institute study.
It’s too soon to know if they’ll succeed.
I-News is the public service journalism arm of Rocky Mountain PBS and works collaboratively with new media throughout Colorado.
On the Net
Colorado Health Institute analysis of dental care and Medicaid: http://coloradohealthinstitute.org/uploads/downloads/2103_Oral_Health_Main_Report_and_Data_for_Web.pdf
