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Some Dentists Reluctant to Treat Kids on Medicaid: Study
Date:5/23/2011

By Maureen Salamon
HealthDay Reporter

MONDAY, May 23 (HealthDay News) -- Undercover research in Illinois reveals that dentists are far more willing to provide emergency care to children with private insurance than to kids with public insurance such as Medicaid.

Posing as mothers of a fictional 10-year-old boy with a fractured front tooth, six research assistants phoned 85 dental practices twice, four weeks apart, to determine the impact of insurance status on the practices' decision to schedule an urgent dental appointment.

Even when calling Medicaid-enrolled dentists, just 68 percent of children with the Medicaid/Children's Health Insurance Plan were able to get an appointment, compared to all of the privately insured children. Non-enrolled dentists offered an appointment to only 7 percent of kids with public insurance despite the fact that Medicaid reimburses all emergency dental care.

"That's a huge difference," said study co-author Dr. Karin Rhodes, director of the division of emergency care policy research at the University of Pennsylvania's School of Social Policy and Practice. "This gives irrefutable numbers. I think there's a real disparity between oral health and traditional medical care in this country."

The study was published online May 23 in the journal Pediatrics.

A fractured front tooth is an urgent, common childhood injury with long-term implications, Rhodes said, including infection, pain and cosmetic problems. Traumatic injuries to permanent front teeth affect one in seven pre-teen children, but more than 10 percent of significant dental fractures go untreated, according to the study.

Nearly half of the randomly selected dental practices called by the researchers were enrolled in Illinois' combined Medicaid/CHIP dental program. In 170 paired calls to both types of practices, a total of 36.5 percent of Medicaid beneficiaries obtained an appointment, compared with 95.4 percent of children privately insured by Blue Cross.

Rhodes blamed the disparity on Medicaid's reimbursement rates to dentists. In Illinois, Medicaid reimburses dentists 53 percent of their median usual fees, placing the state among 25 others below the national average reimbursement level of 60.5 percent for the same procedures, she said.

"I think many dentists shy away from emergency care because they have to follow up" when they know they may not be equitably reimbursed, Rhodes said. "I also found it disturbing a lot of dentists who turned down patients ... said they were willing to see the child if the mother would pay cash."

"I'm very sympathetic to the state," she added. "Illinois is not alone -- I think they're probably in better shape than a lot of places. I think this has implications for a lot of states. It's definitely a wake-up call."

The president of the American Dental Association, Dr. Raymond F. Gist, said the study supports the ADA's longstanding position that better funding for public-assistance programs is critical.

"Lack of funding is among the greatest barriers to better oral health in America," Gist said. "But funding alone will not 'fix' Medicaid. Patients need help navigating an often complicated bureaucracy and overcoming other barriers."

When Medicaid reimbursement rates reach levels that a majority of dentists consider acceptable, participation and utilization increase dramatically, Gist said, citing an ADA analysis of state children's Medicaid programs developed in 2003 and updated in 2009.

"This is a tipping point, rather than a steady-scale phenomenon," he said.

Dr. Burton Edelstein, a professor of dentistry and of health policy and management at Columbia University in New York City, said that despite the study's "disappointing" findings, the problem is beginning to get noticed nationally and a Medicaid group is focusing on a solution.

"The study does typify the problem, but it's getting significant attention," said Edelstein, also president of the Children's Dental Health Project in Washington, D.C. "I'm forever optimistic that the structural changes we're seeking to make in the program will result in greater access to care."

Parents with public insurance who are turned away at a dental office can ask their primary-care physician for guidance or consult local dental schools, which often offer emergency dental care, Rhodes suggested.

More information

To learn more about dental care for children, visit the U.S. National Library of Medicine.

SOURCES: Karin Rhodes, M.D., director, division of emergency care policy research, department of emergency medicine, School of Social Policy and Practice, University of Pennsylvania, Philadelphia; Raymond F. Gist, D.D.S., president, American Dental Association; Burton Edelstein, D.D.S., M.P.H., professor of dentistry and of health policy and management, Columbia University, New York City, and president, Children's Dental Health Project, Washington, D.C.; May 23, 2011, Pediatrics, online


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