ON JULY 1, 750,000 adult Virginians on Medicaid became eligible for dental benefits as part of a two-year state budget that includes $35 million in state and federal money for oral health. Appropriating the money was the easy part. The hard part will be finding enough dentists willing and able to treat all these new patients.
Previously, Medicaid only covered emergency tooth extractions for adults, although pregnant women, children and the disabled were entitled to comprehensive dental benefits. The new benefit will cover teeth cleanings, diagnostic X-rays and exams, fillings, root canals, treatment for gum disease, dentures, and other oral surgeries. The dental benefit does not include cosmetic, aesthetic or orthodontic services.
The American Dental Association Health Policy Institute estimates that the dental benefit will save the commonwealth nearly $14 million in reduced dental-related emergency room visits.
A 2019 report to the General Assembly found that during the prior year, nearly 16,000 Virginians on Medicaid visited the ER a total of nearly 19,000 times for dental-related issues: “More than half (52 percent) were treated for non-traumatic dental conditions that may otherwise have been prevented or treated in a dental clinic, such as tooth aches and loose teeth,” and a third of them made repeat visits to the ER.
At the ER, “at most, patients will get pain management or a prescription for antibiotics and be told to see a dentist,” without addressing the underlying pathology, explained Tara Quinn, executive director of Virginia Dental Association Foundation.
Thousands of people using hospital emergency rooms as free clinics for such problems, knowing they can’t be turned away, is one of the causes of the escalating costs of health care in the commonwealth. Preventive care, and addressing minor dental problems before they become major ones, is a cost-effective way to reduce those costs. Dentistry is definitely one of those areas in which “an ounce of prevention is worth a pound of cure.”
The problem, though, is finding enough dentists who will agree to perform dental procedures and oral surgery at Medicaid rates. Only half of Virginia’s 133 localities have a dental provider who is part of the Medicaid safety net, and 97 communities don’t have enough practicing dentists to support their current population.
In March, Gov. Ralph Northam wrote a letter to Virginia dentists asking for their help by enrolling or expanding their practices to accommodate Medicaid beneficiaries. Statewide, only 1,500 dentists had signed up to serve adults under the expanded Medicaid benefit by the beginning of June. That’s only one dentist per every 500 new Medicaid beneficiaries, and that number doesn’t include the dentists’ existing caseloads.
“The reality is that there aren’t a lot of dentists that are accepting Medicaid,” said Susan Sherman, executive director of the Charlottesville Free Clinic. She added that the clinic, which serves the poor and uninsured, expects to stay busy because “there are a lot of people that aren’t going to receive dental care anywhere else.”
That’s how government “care” works. Politicians promise people health benefits, but refuse to pay full price for them. And then expect private providers to pick up the slack.