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On January 1, 2017, the KHI News Service became part of KCUR public radio’s new initiative, the Kansas News Service. The Kansas News Service will continue to cover health policy news and broaden its scope to include education and politics. All stories produced by the former KHI News Service are archived here. Stories and photos may be republished at no cost with proper attribution and a link back to KHI.org.

Dentist seeks grassroots Medicaid movement

Prairie Village dental surgeon says low reimbursement rates shrinking networks

By Andy Marso | August 12, 2016

A Prairie Village dentist is looking to start a grassroots movement to raise Kansas Medicaid reimbursements in the hope of increasing access to dental care for some of the state’s most vulnerable residents.

John Fasbinder is one of only a few dentists in the state who will do complex procedures, sometimes requiring sedation, for adults on Medicaid — which in Kansas pays about 40 cents on the dollar compared to private dental insurance.

Photo by Andy Marso/KHI News Service Dr. John Fasbinder talks with patient Sarah Matthies at his Prairie Village office.

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Fasbinder organized a conference call of dental providers Thursday. They discussed taking trips to Topeka beyond just the Kansas Dental Association’s annual lobby day, as well as teaming with other medical groups to convince lawmakers to raise reimbursement rates.

Fasbinder said such efforts will create media attention.

“We just need to take advantage of it and organize,” Fasbinder said. “I’m all for it.”

Fasbinder said the 4 percent cuts in reimbursement rates implemented earlier this year to help balance the state budget will increase the financial burden on providers willing to see Medicaid patients, who in Kansas are generally children, pregnant women or elderly and disabled people.

Kevin Robertson, the executive director of the dental association, was on Thursday’s call and said it was an important first step in organizing a lobbying effort. But with the Legislature out of session until January, he said those on the call should focus on local candidates who support their goals in the upcoming general election for state House and Senate seats.

“It starts really on November 8 and who you’re going to vote for,” Robertson said. “I’m not saying who you should vote for in that sense, but you need to vote for people that support dentistry and will support putting money in the Medicaid program in order to bolster some of this stuff. It just can’t be the same old crank down the budget and not fund programs like this.”

Photo by Jim McLean Kevin Robertson, executive director of Kansas Dental Association, frequently testifies on behalf of the state's dentists.

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In Kansas, Medicaid is a managed care program called KanCare that is administered by three private insurance companies: Amerigroup, UnitedHealthcare and Sunflower State Health Plan (a subsidiary of Centene).

Angela de Rocha, a spokeswoman for the administration of Gov. Sam Brownback, said the companies oversee a combined provider network of 395 dentists in 287 locations and 42 oral surgeons in 16 locations statewide. Those numbers come from network adequacy reports for the three companies that are published by the Kansas Department of Health and Environment.

But when a KanCare patient needs complex dental work like multiple tooth extractions or abscess incision and drainage, the networks become much more limited – especially for adults.

Kelly Broadhead, the Kansas Market Manager for Scion Dental, was on Thursday’s call. Her company manages dental benefits for UnitedHealthcare and Amerigroup within KanCare.

Broadhead said she has about a dozen oral surgeons in her networks.

“A lot of them only do children but I do have three providers who will do adults,” Broadhead said.

All three of them are in the Kansas City metro area, she said. But she’s sometimes able to find providers in other areas for adults who just need minor work done.

No one from Sunflower State’s dental benefits manager, Dental Health and Wellness (DHW), was on the call.

But Kim Manthe, who works for dentist Dennis Myers in Troy, said she recently called DHW on behalf of a Sunflower patient who needed more extensive work. She was told Fasbinder was the only one who would do it.

“That’s it,” Manthe said to Fasbinder. “You are the choice. I mean, if that’s not telling you there’s a crisis here for not only adults but kids … it’s huge.”

“A lot of them only do children, but I do have three providers who will do adults.”

- Kelly Broadhead, Kansas market manager for Scion

De Rocha said DHW also does “single-case agreements with oral surgeons to meet special health care needs.”

“So people do receive care, even if they live in areas where there are no surgeons, or there are none who take Medicaid,” de Rocha said via email. “They do single-case agreements with Children’s Mercy, for example, for those kids who have serious medical problems and need specialized dental care.”

De Rocha said there’s another option for the approximately 7,700 KanCare recipients who have intellectual or developmental disabilities. The Kansas Neurological Institute has a dental care unit that is accessible not only for the Kansans who call KNI home, but also for Kansans with similar disabilities who live in their communities.

Still, Fasbinder said his clinic receives 40-plus calls a day from Medicaid clients “begging” for dental services.

Because some complex cases require an operating suite, he estimated that he works out of local hospitals about two or three times a week.

Those appointments are booked through January.

As Thursday’s nearly two-hour conference call wrapped up, several of the dental providers expressed disappointment and frustration at the state of the KanCare dental program.

Fasbinder urged them to remain optimistic and fight for changes.

“Don’t give up hope,” Fasbinder said.