In Kansas, only one in four dentists takes Medicaid patients.
“They’re really not a very charitable group,” Rep. Bob Bethell, R-Alden, said of dentists. “There are some, certainly, who do good things and I commend them. But as a whole, they don’t come anywhere close to meeting the oral health care needs of this state.”
Bethell, a member of the Joint Committee on Health Policy Oversight and chairman of the House Aging and Long-term Care Committee, has been openly critical of the state’s dentists in recent months.
Medicaid uses state and federal funds to underwrite health care for children in low-income families, the frail elderly, and people with disabilities.
“I understand that Medicaid rates are low. I understand that people on Medicaid think that as long as they’re not in pain, they can put off seeing a dentist. And I understand that they miss appointments,” he said. “But they (dentists) have got to do more than they’re doing at the present time because in the big health-care picture, the mouth is just so important.”
Plan in the works
The Kansas Dental Association announced last week that it is putting together a plan that could double the number of dentists taking Medicaid patients.
“Right now, the agreement to take Medicaid patients is 180 pages long and a lot of what’s in there has the effect of saying Medicaid patients have to be treated differently,” said Kevin Robertson, the association’s executive director. “We’re putting together a package that we hope will be more within mainstream dentistry.”
Robertson said the Medicaid agreement, for example, only pays for silver-colored amalgam fillings for rear teeth even though most dentists, nowadays, do tooth-colored composite fillings, which are better looking but more expensive than amalgam fillings.
“So what happens is a dentist looks at that and sees Medicaid telling them they’ll be paid for an amalgam filling even though they only do composites,” Robertson said. “In other words, you’re supposed to treat a Medicaid patient different from the rest of your patients.”
The association, too, he said, will ask legislators to consider raising the state’s Medicaid rates, which fall far short of covering a dentist’s costs.
“It’s been 10 years since reimbursements were last increased,” Robertson said.
In the fiscal year that ended June 30, Medicaid paid Kansas dentists $40.2 million ($12.2 million of which were state dollars) for seeing more than 130,000 patients.
Medicaid headaches
He said relations between dentists’ and the Medicaid program have long been strained.
“There have been several headaches – delays in getting claims processed, Medicaid changing the rules and then telling dentists they have to pay money back and trying to figure out what’s covered and how to bill for it.”
Rep. Bob Bethell, R-Alden
Many dentists, he said, would rather donate their services than “go through the hassle of getting reimbursed by the government.”
According to the association’s calculations, Robertson said, each Kansas dentist, on average, provides $33,000 annually in charity or reduced-fee care.
It didn’t help matters, he said, when late last year Gov. Mark Parkinson ordered an across-the-board, 10-percent reduction in Medicaid payments and when legislators later dropped dental care from Medicaid-funded programs for pregnant women, the frail elderly and people with disabilities.
“When dentists get together, these are the kind of things they talk about,” Robertson said. “These stories stay with them forever.”
The 10-percent cut in Medicaid reimbursements was restored on July 1.
Funding to reimburse for dental care for Medicaid-eligible pregnant women, frail elders, and people with disabilities was not.
What about a mandate?
Maggie Smet, president of the Kansas Dental Hygienists’ Association, works for Dr. R.J. Tippin, a dentist whose practice, Tippin Dental Group in Newton, sees Medicaid patients.
“If it were up to me, I’d have the state dental board mandate (that dentists accept patients on) Medicaid,” Smet said. “That would go a long way toward serving the underserved and let’s not forget that when you’re talking Medicaid, it’s mostly children.”
Last month, Medicaid covered roughly 47,000 children between ages 6 and 17 in Kansas.
Dentists are licensed by the Kansas Dental Board.