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New dental coverage may strain access to care Date: 01/13/14

Michael Booth

By Mary Otto

I recently wrote about Michael Booth’s story for The Denver Post about the worsening shortage of dental care in Colorado: “Flood Of New Dental Patients in Colorado Meets Trickle of Caregivers.”

In his story, Booth explained that “hundreds of thousands of Coloradans will have new dental care benefits in 2014 under twin health-reform efforts, but state leaders now must scramble to find providers who will care for them.”

It is expected that 335,000 adult Medicaid beneficiaries will gain access to dental care in the spring and that tens of thousands more will join Medicaid rolls under the Affordable Care Act expansion. In addition, thousands of children could get new dental benefits when their parents buy coverage on the state’s insurance exchange, Booth wrote.

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

The story described a very challenging road ahead for dental patients and providers in the state.

Booth was kind enough to offer some insights into how things may play out in the coming months in Colorado, as well as some advice to the rest of us who are watching this issue.

Q: As you wrote, part of the health care reform effort in Colorado involves offering dental coverage to poor adults who are covered by Medicaid. Medicaid dental benefits for adults are optional for states and, in many places, they are extremely limited. Can you tell us a little more about the Medicaid dental benefits that adults will be eligible for in Colorado? What kind of procedures will be covered?

A: Medicaid officials and panelists from various dental care groups are working that out between now and April when the coverage begins. The potential high costs to the state if a lot of people start using the benefit could lead to a big debate over how much preventive and maintenance work to fund, versus restorative and cosmetic care.

Q: From what you have heard so far, what do the pediatric dental benefits look like on the Colorado exchange? Do you get a sense families are buying them for their children?  

A: Like most dental policies, many plans feature some basic free or close-to-free preventive services in a year, with a lot of cost-sharing for anything beyond that. Too early to tell what people are buying, as the exchange is still ramping up basic health enrollment and has not started breaking out detailed demographics or policy options among those actually purchased.

Q: As you pointed out in your story, many dentists in the state have been reluctant to accept Medicaid patients, complaining of low reimbursement rates and bureaucratic red tape. Are advocates, dental and public health officials confident that raising the rates and cutting the paperwork will increase the number of Medicaid providers enough to meet the growing demand for care? Do they have other ideas in mind?

A: I'd say there's still huge skepticism in the dental care community that either their rates can be raised or the bureaucracy can be cut enough to create a rush back to the program. It may take a lot of peer convincing by true believers among the dentists to bring enough colleagues to the program to make it all work.

Q: You also touched upon about another aspect of the problem that might be even more difficult to address: the fact that nine Colorado counties may not even have a dentist. What do you think will happen in those places? Are grassroots groups suggesting alternative provider models such as dental therapists?

A: There are public health advocates who want to push the boundaries of what hygienists and people at less-than-dentist levels of training are allowed to do. These are always fierce battles in the Colorado Legislature and in the regulatory boards that make the decisions. In the meantime, nonprofits are trying to push existing solutions, including the idea that many more young children could be reached with cavity-preventing varnishes through pediatricians' offices.

Q: Do you have a few words of advice for other reporters who might want to tackle a story like this in their own states or communities?

A: Many states have dental care-focused nonprofits that keep better information and present it more clearly than state health officials, so go to them early. Ask your state Medicaid office what their current status is on providing dental benefits to adults, and whether that is under reconsideration. And there are often researchers at your university's school of dental care who are studying public health aspects such as rural care and approving new procedures by nontraditional providers.