Medicaid dental program needs reasonable rates to draw dentists

Published - November, 27, 2006

Medicaid dental program needs reasonable rates to draw dentists

State Sen. Durell Peaden, R-Crestview, astutely summed up the situation with the state's Medicaid dental program: "You can't reform what you're not funding appropriately to begin with."

He's right.

For Gov. Jeb Bush and the Legislature, "reform" too often seems to mean cutting services and putting program management in the hands of private companies that then look to further "reform" the system by carving their profit margin out of what's left.

The problem of too few dentists in the Pensacola Bay Area not accepting Medicaid patients looks pretty simple: The program already pays so little that it costs dentists money to accept them.

"Dentists can't afford to keep their doors open just getting 10 cents on the dollar," Peaden pointed out.

It is fine to talk about the need for dentists to step up to meet social and professional responsibilities, but expecting dentists to lose money in doing so isn't fair. Charity freely given is one thing -- and if nothing else, it is tax deductible. But saving the state money by asking dentists to absorb a loss is something else.

We expect many dentists would be happy to accept Medicaid patients even if it meant not earning as much as they make from their regular patients. Or, if they could at least depend on breaking even.

But running the program by stiffing dentists is not the way. The natural result is for dentists to decline to participate.

Which, frankly, might be the point.

Either way, it marks a significant failure on the part of state government.

The Medicaid dental program is a limited one. It provides basic services that provide relief for problems that, left untreated, can debilitate sufferers and lead to worse problems -- the kind that send people without insurance to emergency rooms, the most costly kind of health care.

For adults, Medicaid covers only dentures and emergencies, such as tooth extractions. Children are offered more services, which is critical. Dental needs ignored in childhood can become lifelong problems.

Medicaid was designed to provide a basic level of health care for a segment of society unlikely to get it elsewhere. They are either unemployed or hold low-paying jobs that don't provide health insurance.

States face large and growing costs for Medicaid, so it is reasonable that they look to limit costs. But making the system unworkable isn't "reform."

Right now, a combination of bare-bones public and private resources are available to serve Medicaid patients. That includes health departments in Escambia and Santa Rosa counties, Sacred Heart Health System, five area dentists who accept children as patients, and the Florida Baptist Convention, which provides visits once a year by a mobile office that offers only extractions.

Bringing reimbursement rates up to a reasonable level should bring needed dentists into the program.

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We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org