Colo. advocates predict newly insured patients will overwhelm dentists

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health, curating related material at healthjournalism.org. She welcomes questions and suggestions on oral health resources at mary@healthjournalism.org.

Hundreds of thousands of adults and children in Colorado will soon get dental coverage thanks to health care reform efforts in the state.

But many of these new beneficiaries may have trouble finding a dentist to treat them, writes Michael Booth in a good story for The Denver Post, “Flood of new dental patients in Colorado meets trickle of caregivers.”

“A new dental benefit for adults with Medicaid, coupled with an Obamacare expansion of eligibility and pediatric benefits required on the state exchange, will balloon the number of paying patients,” he explains.

“About 335,000 current Medicaid adults gain access to dental care in the spring, and tens of thousands more will join Medicaid rolls under the Affordable Care Act expansion. Added to them will be potentially thousands of privately insured children with dental care included under “essential benefits” minimums of the state health exchange.”

But health advocates warn that if just a quarter of the newly enrolled Coloradans start using their dental benefits, the system will be strained.

“Having the benefit is a great positive step, but it’s creating an access problem as well,” Karen Cody Carlson, executive director of the nonprofit Oral Health Colorado says in the story.

According to statewide surveys and licensing records, Colorado has about 3,600 dentists. Of those, about 1,000 are actively enrolled as Medicaid providers, Carlson tells Booth. And of that 1,000, only about 690 take enough Medicaid patients to bill more than $10,000 in claims in a year.

As in other places, many Colorado dentists decline to participate in Medicaid, complaining about the program’s low reimbursement rates and bureaucratic red tape.

But with the need to lure more providers into the fold getting urgent, dental and public health officials as well as advocates in the state are pushing to streamline Medicaid signup and payment systems.

Meanwhile, the Colorado State Dental Association has launched a “Take Five” effort to get each dentist in the state to accept at least five Medicaid patients or families in the coming year, Booth reports.

Health care journalists take note: With health care reforms going into effect and new children and, in some cases, adults becoming eligible for dental benefits, there may be a similar story unfolding in your state.

Simplified Medicaid administration is something that the American Dental Association (ADA) has called for nationwide as part of an Action for Dental Health Campaign.

(A combination of fee increases and administrative reforms in Connecticut in 2008 increased the number of participating dentists from less than 200 to more than 1,200, the organization says.)

The shortage of Medicaid dentists is a problem the Pew Charitable Trusts has taken aim at in a number of reports including this one.

But the lack of Medicaid dentists is just part of the problem. Some places, including many rural areas, lack dental providers of any kind to take new patients regardless of the kind of coverage they have.

There are about 4,600 Dental Health Provider Shortage Areas (HPSAs) across the country – areas where 5,000 or more people are depending upon one dentist – based upon the calculations of the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA).

Based on this formula, it would take approximately 6,600 additional dentists to eliminate the current dental HPSA designations, officials say. Check this link to see if there is a dental HPSA in your area.

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