Community Forum: Dentists hamstrung by Medicaid
This week’s writer is Dr. Jim Cossaart, DDS, of Bristol Park Dental.
If you have Vermont Medicaid insurance for your dental needs, you have a poor policy, and you will likely get results of the same. Many more Vermonters have joined the ranks of those eligible for Medicaid — but the state has not funded the program adequately. Many Vermont adults have discovered that most dentists will not accept Medicaid as payment.
The disbursement rates paid to dentists in Vermont is nothing short of shameful. It would be like the state announcing that a new 10-mile highway would be built, but they will only pay for 6 miles.
As a dentist, if I treat an adult Medicaid patient, the reimbursement rate paid to me covers about 60 percent of my total costs. I love my patients and want to get them out of pain and return them to a healthy state. But if, in effect, I am paying the patient to treat them, why would I do it? And high-risk dental problems like wisdom teeth require an oral surgeon, whose costs are even greater. The few oral surgeons we now have must absorb even bigger losses.
Let’s take an example of a young adult of modest means that wishes to fix up his or her teeth to improve not only their health, but also to get a job. If they are lucky enough to find the rare dentist that will accept new Medicaid patients, they are limited to $510 in benefits per year. After an initial exam, X-rays and a necessary cleaning, they are left with about $260. That will cover about three fillings — or two to three extractions — but not both. That’s all they get, until next year. And Medicaid will not pay for even the cheapest denture.
If the patient needs more work than $510 will buy, the patient may pay out-of-pocket. But legally I can still only charge for fillings and extractions at the same rate that covers 60 percent of my costs, and most Medicaid patients cannot afford even that amount. So, the more work I put into them, the bigger my financial loss.
Hospital emergency rooms have become overrun with acute dental infections, most often severely abscessed teeth. The already-overworked ER docs cannot fix the underlying problem, and antibiotics and pain meds merely postpone a chronic condition. And by the way, there is no upper limit on Medicaid medical payments. For the life of me, I cannot understand why there can be thousands of dollars spent to treat acute dental infections, yet the system’s inflexibility limits prevention and restorative procedures — things that a dentist does — to 510 bucks annually.
It is common knowledge that the state of Vermont is facing a Medicaid funding crisis, so where they are going to come up with the money to fix this is beyond my knowledge. Like so many other states in America, it is likely going to take a more robust participation by the federal government to fix this. There is a lot of discussion lately about income inequality and the emergence of a permanent underclass. As a dentist, I see this problem in the form of far too many hardworking people using the emergency room as a de facto dental office and missing employment opportunities because they are too busy suffering with a mouth full of rotten teeth.
When I graduated from dental school, I took an oath to do my best to provide for my patients’ oral health. But if they happen to have Medicaid insurance, in a very real sense, I am not permitted to do my job adequately.
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