Safety-net clinics filling gap in dental services to low-income Kansans

0 | Workforce, Oral Health

— Less than one-third of the dentists in Kansas see Medicaid patients, according to a national report.

And only 14 percent of the dentists who do are considered “significant providers,” meaning they billed Medicaid for more than $10,000 a year in services.

The state report, “Keep Kansas Smiling,” was part of a 2009 Oral Health America assessment of oral health reform efforts in all 50 states.

“If you’re on Medicaid, access is definitely an issue,” said Kansas Association for the Medically Underserved Executive Director Cathy Harding. “In fact, in some of the state’s more sparsely populated areas there isn’t even a dentist — not to mention a dentist who’ll take Medicaid.”

Audio clip

Jim McLean’s KPR piece on Medicaid dental expansion

Listen to Audio Clip

The state’s $2.5 billion Medicaid program provides medical services for children and pregnant women as well as people with disabilities and very low income adults. Children enrolled in the program also receive dental services, but adults do not.

Though Kansas was awarded an overall grade of “B,” the report makes it clear the state would have received a “C” if not for the “extra credit” points it earned for new policies that allowed registered hygienists to provide preventive care in certain settings and expanded the dental services available through the state’s safety-net clinics.

Push for adult benefit promised

photo

Tanya Dorf Brunner, executive director of Oral Health Kansas.

View larger photo

Kansas received a low “D” in the oral health report’s important access-to-care category, in large part because its Medicaid program doesn’t include general dental coverage for adults.

But a statewide coalition is out to change that. Tanya Dorf Brunner, executive director of Oral Health Kansas, said recently that the organization was preparing to renew its push to add an adult dental benefit to Medicaid. She said adding the benefit is more important than ever because the federal health reform law is expected to make more than 100,000 additional Kansans eligible for Medicaid.

“I think we’ll be able to make a strong case,” she said. “But I can’t begin to describe how difficult this is going to be.”

In 2007 and 2008, state legislators expanded Medicaid to include dental care for pregnant women, people with disabilities, and the frail elderly. But plummeting state revenues forced Gov. Mark Parkinson and legislators to eliminate the benefit earlier this year.

HealthWave access also a problem

HealthWave, the state-run health insurance program for children in low- and modest-income families that earn too much to qualify for Medicaid, covers dental care, but most dentists are also reluctant to take on HealthWave patients.

“It’s really hard to find a dentist who’ll take HealthWave,” said Dave Sanford, executive director at GraceMed Health Clinic in Wichita. “So, we see a lot of HealthWave kids at the clinic.”

Sanford says that many dentists complain that they lose money on HealthWave patients because the payments they receive from the state don’t cover their costs.

KAMU represents the 38 charitable safety-net clinics in Kansas, most of which serve Medicaid and HealthWave patients as well as the uninsured and underinsured. Seventeen of the 38 clinics offer dental services.

But maintaining these services, let alone expanding them to meet the increased demand that the health reform law is expected to generate, will not be easy, Harding said.

“Our biggest challenge is being able to recruit and retain dentists who are in a position to come to Kansas and work with this population,” Harding said. “There just aren’t that many of them out there, and when you do find one, the competition is intense.”

One dentist’s decision

Recruiting dentists to the state’s safety-net clinics is difficult, but it can be done.

Take Dr. Andrea Boothe, for example.

A recent University of Missouri-Kansas City dental school graduate, the 28-year-old Boothe started work in July at the GraceMed Health Clinic’s dental clinic.

“I’m from the Wichita area, so for a long time I’ve just felt like this is something I would like to do,” she said. “I’m definitely getting to do a lot more here than I would have if I’d gone into private practice.”

She’s also taking advantage of a government loan-repayment program that’s expected to trim $25,000 a year from the $200,000 debt she incurred during her four years in dental school.

More dental school graduates would come to safety-net clinics in Kansas, Boothe said, if the state did more to help cover the costs of their schooling.

“Loan repayment — that’s a huge worry,” she said.

“I think there are a lot of students who would be interested in doing what I’m doing if there was a way to help them get more of their loans paid off,” Boothe said. “I’m lucky because I’m from here, this is where I want to practice, and I’m getting some of my loan paid off.”

Related coverage: Kansas' Oral Health Care Provider Shortage

Bill considered that would allow dentists to have more practice locations (2/18/14)
Statehouse push made for mid-level dental practitioners (2/12/14)
Americans for Prosperity joins effort to license mid-level dental providers (1/8/14)
Kansas Medicaid program still lags nation in oral health care for kids (11/12/13)
Kansas dental program for children on hold because of KanCare MCO (11/11/13)
Dental mediation effort ends without compromise (11/4/13)
Disputing parties enter formal mediation over mid-level dental providers (10/3/13)
Pew report cites need for mid-level dental providers (6/25/13)
Dentist groups announce scholarships for dentists going to rural areas (2/7/13)
Advocates for mid-level dental providers meet with legislators (2/6/13)
Bill to license mid-level dental providers introduced (1/29/13)
Regents will hear proposal to train mid-level dental practitioners (10/17/12)
Dentist shortage proposal not funded in Regents' recommended budget (9/20/12)
Report questions economic viability of mid-level dental providers (7/26/12)
Task force recommends building state's first dental school (6/21/12)
Dentists shouldn't fear mid-level dental care, expert says (4/20/12)
No consensus on how to end ‘dental deserts’ (4/9/12)
Worldwide review says mid-level dental providers give good care (4/10/12)
Bill to increase dental care access given initial approval in Senate (3/15/12)
New caucus told of oral health success in southeast Kansas (3/8/12)
More Kansans head to ER for dental care (2/29/12)
Dental association says new program will increase access in rural areas (2/2/12)
‘Turf battle’ continues over dental practitioner bill (1/30/12)
Summit to focus on training plan for mid-level dental practitioners (11/29/11)
Between a hygienist and a dentist, a hard sell (10/26/11)
Political fight continues over mid-level dental practitioners (10/11/11)
Better prevention would help solve dentist shortage, advocate says (7/22/11)
Dentists: Practitioner bill flawed (3/9/11)
Videos detail shortage of Kansas dental providers (12/8/10)
Slow going in efforts to solve state’s dentist shortage (8/30/10)
Safety-net clinics filling gap in dental services to low-income Kansans (8/30/10)
Replacing town’s only dentist ‘hardest’ project ever (8/30/10)
Progress made on oral health, but problems remain (1/14/09)
Funding bill contains seed money for 'dental hubs' (5/4/07)
Increasing access aim of oral health coalition (12/21/06)



The KHI News Service is an editorially independent initiative of the Kansas Health Institute. It is supported in part by a variety of underwriters. The News Service is committed to timely, objective and in-depth coverage of health issues and the policy-making environment. All News Service stories and photos may be republished at no cost with proper attribution, including a link back to KHI.org when a story is reposted online. An automatically updated feed of headlines and more from KHI can be included on your website using the KHI widget. More about the News Service at khi.org/newsservice or contact us at (785) 233-5443.