Almost half a million Coloradans are expected to gain dental benefits under Medicaid by 2016. That doesn’t mean they’ll be able to see a dentist.
Two state policy changes rolling out next year are intended to improve access to oral health care for low-income Coloradans. The state legislature earlier this year voted to expand Medicaid’s dental benefits to adults – it now only covers children for most kinds of care.
The change will go into effect around the same time as Colorado expands Medicaid coverage under the Affordable Care Act to those who make slightly more than the federal poverty level.
The pair of changes is expected to grow the ranks of Medicaid enrollees with dental benefits to 844,491 in 2016, from 348,142 last year, according to a study released Tuesday by the Colorado Health Institute.
But 17 counties in Colorado don’t have a dentist who accepts Medicaid, the study reported.
Some rural areas simply don’t have dentists at all – you won’t find one in sparsely populated Kiowa County in the eastern plains, or in southern Colorado’s Mineral County, the institute found. In more populous Delta and Elbert counties, there are dentists – but none that take Medicaid.
Chaffee County ranks among the areas with a low percentage of dentists accepting Medicaid. Cara Russell heads the county’s program to improve oral health, which works to educate people on the importance of good oral hygiene.
Preventive dental care can keep people from showing up in pain at emergency rooms and in need of expensive surgery. Poor oral health is also associated with chronic diseases like diabetes and heart disease, according to recent studies cited by the Centers for Disease Control.
But inspiring someone to go to the dentist doesn’t get them there, says Russell. For those living in her area of the state, the nearest dentist accepting Medicaid is often a drive of 65 miles to 110 miles. At the same time, much of the working population will remain uninsured even as Medicaid expands.
“We are on the verge of much better care for our underserved population,” says Russell.
“But we’re not there yet, and the transition is going to be painful.”
In the southeastern Colorado town of Walsh, Carol Morrow is the only dentist in Baca County, population 4,500. She accepts Medicaid, making her office an oasis in a dental desert. Some patients drive hours to get to her.
“I think every person deserves the same kind of care, whether they can afford it or
not,” says Morrow. The expansion of Medicaid benefits to adults will allow her to get some compensation for care she now provides for free, she says.
Morrow is participating in a new push by the Colorado Dental Association to encourage more dentists to accept Medicaid as the policy changes unfold.
The professional group is fighting a perception among some dentists that the paperwork is too cumbersome and reimbursement rates too low, and an unfounded fear that Medicaid patients will fail to show up for appointments, says Jennifer Goodrum, who directs the organization’s government relations.
Jeff Hurst, who runs a practice in Lakewood, is one of the Colorado dentists who doesn’t take Medicaid. The 40-page application form to become a Medicaid doctor is one barrier. Payment is another reason Hurst stopped seeing Medicaid enrollees. The state is slow to process claims, and the reimbursement doesn’t even cover his office’s overhead costs, he said.
However, Hurst is heartened by recent moves by state officials to make it easier to navigate the application and payment process and hike reimbursement rates.
“Removing these barriers will allow us to treat these patients the same way we treat others,” says Hurst. “These adults – some of which have never had care – can get introduced to the world of dentistry.”
Still, improving access to dental care is likely to take creative thinking in places as far-flung as Delta County on the western range, Conejos County to the south, and a huge swath of the eastern plains where Medicaid enrollees far outnumber dentists willing or able to provide services.
Expanding the role of dental hygienists may be one solution, while boosting the capacity of dentists that already see low-income patients may be another route.
“Communities are gearing up and getting ready,” says Sara Schmitt, one of the authors of the Colorado Health Institute study.
It’s too soon to know if they’ll succeed.