A new report by the Pew Charitable Trusts, embargoed until 12:01 a.m. on Tuesday, June 25, takes a state-by-state look at the complex problem. It also targets two factors for blame: the uneven distribution of dentists that leaves thousands of communities underserved; and a shortage of dentists willing to accept Medicaid patients.
According to Pew’s analysis, contained in the new report “In Search of Dental Care: Two Types of Dentist Shortages Limit Children’s Access to Care,” 14 million Medicaid children received no dental care in 2011. The lack of care was particularly dramatic in some states, such as Florida, where 76 percent of Medicaid children went without a dental visit, the Pew study found.
The problem of access can be expected to get worse, Pew contends, as millions of additional children become eligible for Medicaid under health care reform and as tens of thousands of the nation’s dentists reach retirement age.
Based on data gathered from the government and from the American Dental Association, the report includes a state-by-state breakdown of the percentage of Medicaid children who went without care in 2011, as well as the percentage of dentists approaching retirement age and the percentage of the state population determined to be underserved and living in a dental shortage areas.
Pew has been a leader in the movement to expand dental services through the use of technically-trained auxiliaries known as dental therapists. The philanthropy uses the findings in the report to bolster the case that more states should follow the lead of Alaska and Minnesota and put the midlevel providers to work. But such efforts are being strongly opposed by the American Dental Association. In its own recent series of reports and newly unveiled “Action for Dental Health” campaign, the ADA acknowledged a crisis in dental care for the poor, the elderly and the isolated.
But ADA officials maintained that the nation’s existing dental workforce is capable of meeting current needs as well serving new patients entering the system through the Patient Protection and Affordable Care Act.
While opposed to dental therapists, the ADA favors a community dental health coordinator model, where individuals from the community are trained to work within the existing system to help patients locate dentists and negotiate barriers to care, such as finding transportation to appointments. And it offered a variety of other approaches to getting care to the poor, the elderly and the isolated. The group laid out initiatives that would divert uninsured patients with dental emergencies from hospital ERs to local dentists and clinics; encourage more private practice dentists to contract with federally qualified health centers (FQHCs), increase the charity care offered to poor children; expand care to nursing home patients and streamline Medicaid credentialing processes on a state-by-state basis.