When I graduated dental school, I decided to return home to Concord to run a pediatric dental practice that provided care to all children, including those with special health care needs and those with a limited ability to pay. Many of these children experience exceptionally high rates of dental problems, partially because high quality dental care is often unavailable to them. While I knew that serving these children wasn’t the most lucrative path for my career, I’ve always believed that if I treat the needs of my patients and their families, and if I treat them with respect, then things would work out financially for my practice.
While I’ve been able to keep the lights on and the doors open, bringing in enough income to cover the practice’s expenses has been a challenge. Many of my patients rely on Medicaid for their dental insurance. Medicaid is a great program and we wouldn’t be able to serve nearly so many children if it weren’t around, but the amount Medicaid pays for the services we provide these patients doesn’t begin to cover the costs.
For children with special health care needs, Medicaid reimburses my practice at a rate of approximately 30 percent of the actual cost of care. These children need extra patience and attention, which means more time in the chair and more staff in order to complete their treatment. They tend to have high rates of dental decay and more demanding treatment needs requiring advanced behavior management techniques, such as sedation and general anesthesia, which require additional permits, increased malpractice insurance, and sophisticated monitoring equipment—all of which increase the cost of care. Many of these children need more than half of their twenty primary teeth restored with fillings or crowns, so it can be a challenge to identify a treatment strategy that is both effective and cost-efficient. Even for a standard six-month exam and preventative care appointment, I reserve an hour of my time and that of three assistants to complete the treatment.
Though disappointing, it’s not a surprise that many dentists don’t treat children with special health care needs or any children on Medicaid given the financial challenges. This has resulted in serious access-to-care problems in many areas of the state. That’s why increasing and maintaining reasonable reimbursement rates for dental providers is critical in assuring safe and appropriate dental homes and treatment for these children.
Unfortunately, this problem could get worse before it gets better. President-elect Trump and Congressional leadership are considering proposals to block-grant Medicaid or impose per capita caps, which would result in massive federal funding cuts for state Medicaid programs. Deprived of a crucial funding source, North Carolina could cut reimbursement rates for dentists or even eliminate the Medicaid dental benefit, leaving over one million children with no dental coverage at all.
Policymakers at the state and federal level must remember that oral health is critical for a child’s overall health and success. To ensure that children have access to dental care, state legislators, Congress, and President-elect Trump must work together to strengthen Medicaid and increase reimbursement rates for dental providers.