February 7, 2013
Back in the old days, community dentist’s pleas were, “Help us! Help us any way you can…send…help…now!” And you did.
With great pushing and guidance, our nation’s legislators have gone from spending $756.1 million on dental Medicaid in 1990 to $7.4 billion in 2010.
During the 1990s, Washington state spent quite a bit of money building and funding the operations of Community Dental Health Clinics. We currently have about fifty federally qualified dental clinics. They form the primary safety net for dental patients in poverty.
There are also quite a few private non-profit dental clinics that many of you staff and fund. Olympia’s Union Gospel Mission is a fine example of one.
WSDA calculates that member dentists provide over 100,000 patients pro bono care each year. Because you are humble we believe this number is underreported.
The University of Washington School of Dentistry, Children’s Hospital, Odessa Brown Dental Clinic, The Northwest Dental Residency and Lutheran Medical Dental Residency programs also contribute to the safety net.
We are developing new strategies for treating low-income patients with special needs. Amy Winston and Bart Johnson partnered with the Seattle-King Dental Society and Swedish Hospital to build a small clinic in the hospital. This clinic treats patients referred from the emergency room, patients with difficult extractions that King County FQHC’s need help with, and low-income patients needing organ transplants. The clinic is doing quite well. We hope other hospitals adopt this program.
Many of our dental societies have programs designed to screen low-income patients and set them up with private practice dentists.
Our infrastructure has grown and with our hard work combined with insight, hopes and dreams it will continue to grow.
So where are we now. Let’s start with children. It may surprise you that many people, including me, do not feel there is an access problem for children in this state. There are many things that have contributed to this concept.
Washington state has the second lowest level of untreated dental caries in the nation. At 52.4 percent, we also have the 8th highest Medicaid utilization rate in the nation. The Pew Charitable Trusts just ranked us among the top fifteen states providing dental sealants for children. That speaks very well for all of our efforts. To contrast, Medicaid eligible children in Washington utilize dental care only 5.6 percent less than children with private insurance.
While we want every child to go to the dentist, historically they have not. Utilization rates tend to be stable. At this time most low-income clinics can get children appointments the same day or within a day of being called by a parent. In urban low-income clinics, like my clinic, it feels like we are competing for Medicaid children.
Currently Medicaid eligible adults are our most vulnerable population. Today there are approximately 488,000 Medicaid eligible adults in Washington. Of those, only pregnant women, long-term care patients, and the developmentally disabled are eligible for non-urgent dental care. That translates into about 38,000 patients having a comprehensive dental benefit at any given time.
Our community health network was set up to provide care for both adults and children. Cutting adult Medicaid coverage in 2011 meant that clinics could not continue to see adults for free and stay afloat. Many patients of record that were offered sliding fee payments could not afford to continue their care. Our appointment books were suddenly empty, but adults with tooth pain still begged for free care. No clinic, public or private, can live without funding. The clinics have done the best they can by seeing children and seeking private funding to offset the cost of non-paying adult patients. In this economy, private donations are difficult to find and keep.
Guess what happens when you lose your adult population? You don’t need your hygienist as many hours, if at all. I have worked shoulder to shoulder with these dedicated dental souls, and now I worry about their jobs. Welcome to my real world workforce problem.
It is always difficult to be a poverty dentist. It is hard to pick up the pieces when your patients have neglected their care and health to the point of where their needs may be so severe that they are almost outside of the scope of practice for a general dentist. It is much harder when there is no money to treat them.
It breaks my heart to see money being spent in emergency rooms that could go so much farther in the safety net clinics we worked so hard to build. We need to rethink our funding. We need to utilize our current resources. The community health network we built is ready to work. Just fund us!
* Most of the data here came from WSDA’s “Strengthening the Dental Safety Net,” written by Bracken Killpack. Thank you Bracken!