Finding dentists who take Medicaid is like pulling teeth

Vancouver woman had to trek to Seattle to get care

By Marissa Harshman, Columbian Health Reporter

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When Amreal Presler first started experiencing dental pain in early July, she made an appointment with her dentist right away.

X-rays revealed the 22-year-old Vancouver woman needed to have her tooth pulled, but the angle of her tooth’s root would make the extraction complicated. Presler was referred to an oral surgeon.

She had two options: Pay $900 out-of-pocket for the procedure or have it performed at no cost to her by a provider who accepts her insurance.

The catch, however, was in order to find a provider accepting her insurance, Presler would have to wait seven months and drive to Seattle. That’s because Presler is covered by the state’s Medicaid program, and few dentists and dental specialists are willing to see Medicaid clients.

“If you can afford to pay out that much money (out-of-pocket), you wouldn’t be on Medicaid,” said Presler’s dad, Paul Presler.

So, despite having dental insurance, Presler found herself at the bottom of a waiting list for an oral surgeon 170 miles away.

Patients turned away

In January 2011, the state dramatically reduced dental services for adults on Medicaid, covering only extractions, treatment of trauma-caused damage. and temporary relief of pain or infection.

But with the passage of the Affordable Care Act and the state’s decision to expand Medicaid coverage to include more adults, state officials made the decision to reinstate its adult dental program that covers the full slate of preventive and dental care.

The problem, as many Medicaid clients are finding, is many dental providers will not accept Medicaid.

According to the state Health Care Authority, which oversees the Medicaid program, only 34 Clark County dental providers have filed claims for reimbursement from January through September of this year. During that time, 2,556 local adults on Medicaid received dental care, according to the state.

“Finding a dentist in some of our communities can be challenging,” said MaryAnne Lindeblad, Medicaid director for the Health Care Authority. “Southwest Washington is an area where there is probably not an adequate number of dentists willing to see Medicaid.”

Local dentists say they’re turning away Medicaid clients because the state reimbursement rates for services — which are the same now as they were in 2010 — are too low.

“They haven’t increased the amount being reimbursed, so dentists just aren’t accepting it,” said Dr. Kristine Aadland, a Vancouver dentist and former Clark County Dental Society board member.

“We can’t even pay our hygienist to do a cleaning,” she added.

Dental offices are reimbursed about $30 for cleanings. The hourly wage of a hygienist performing the work is $34 to $36, she said.

As a result, the “vast majority” of Clark County dentists are not accepting Medicaid clients, Aadland said.

“They just can’t afford to,” she said.

Dental specialists are turning away Medicaid clients, as well, said Dr. Scott George, an endodontist and president of the Clark County Dental Society. The overhead costs for specialists are often much higher than those of general dentists, he said.

“The reimbursement rates are even more cost-prohibitive for a specialist,” George said.

Medicaid reimbursement for a root canal, for example, is 60 percent less than the customary fee for the service, he said.

“The care is available in Vancouver, but usually if (Medicaid) is their only way to help pay for their treatment, you can’t do treatment at that level,” he said.

That’s something Presler and her dad heard often.

While waiting for an appointment at the University of Washington School of Dentistry, Presler’s oral pain persisted. Her tooth broke while she was eating one day and her face began to swell.

She went to an urgent care clinic on Aug. 31 — her dentist and medical provider told her they couldn’t help her — and learned her tooth was infected. Presler received antibiotics for the infection and 800 milligram ibuprofen tablets to help with the pain, but the problem tooth remained while Presler waited for an appointment.

Paul Presler called every oral surgeon he could find in Clark County. Nobody would accept Medicaid. He even tried Portland providers, but they wouldn’t accept Washington Medicaid clients.

One dental office, however, told Paul Presler that Harborview Medical Center in Seattle has a dental program and was accepting Medicaid clients.

Amreal Presler called and was scheduled for a consultation on Sept. 9. When she arrived that morning, the dentist took one look at her tooth and told Presler she had an abscess and the tooth needed to be removed right away. They performed the extraction that day.

“It took seven minutes to pull out,” Presler said. “All of that for seven minutes to get it out of my mouth.”

Budget challenges

State officials are looking for ways to increase rates, Lindeblad said, but the state has continued to have budget challenges.

“While certainly the economy is improving and there’s more money, there are demands on those dollars,” she said.

Many Medicaid clients across the state receive dental care through federally qualified health clinics, which receive higher reimbursement rates than private practices. Areas with more of those clinics have better access, Lindeblad said.

Clark County has only one federally qualified health clinic: Sea Mar Community Health Centers.

Sea Mar operates one dental clinic in Vancouver with two dentists and one part-time hygienist. The office is booked several months out, with providers seeing 32 to 40 patients per day, said April Guzman, Sea Mar’s regional dental manager.

In addition, the clinic usually sees about five to 10 urgent care walk-in patients and hears from 40 to 50 new patients looking for care every day, Guzman said. The clinic has always been busy, since it offers a sliding scale for payment and doesn’t turn patients away for their inability to pay, but the volume has increased slightly since the Medicaid program restored the dental program, she said.

Sea Mar hopes to open a second dental clinic in Vancouver sometime next year to try to keep up with the need.

“The demand is definitely great,” Guzman said.