For Immediate Release
Date: Apr 28th, 2015
Contact: Dr. Robert Henry
KDAS Dental Access Summit Saturday, January 31, 2015 Report to KDA Part I
During the 2014 Kentucky Dental Association (KDA) General Assembly meeting, the House of Delegates established a Work Group to investigate and gather information on the “Access to Care Issue in Kentucky”. Purposely this charge was vague and was left to the workgroup to define. From the initial meeting it was determined that the workgroup would focus on two goals:
1) Collect information about what is currently being done in Kentucky to provide dental care services for people who are uninsured, underinsured or without financial resources to pay for dental care; and
2) What needs to be done to manage or improve dental access issues for the people who are uninsured, underinsured or without financial resources to pay for dental care?
A comprehensive search was done by the group to determine what dental providers in the state offer programs (including Medicaid), to people with financial or other access problems. This document “Dental Access Clinics and Programs: Contact Information by County and KDA Component Society”, is now available on the KDA website and will be updated regularly.
To address the second goal regarding “what needs to be done”, a one day conference, called the “Dental Access Summit” was held on Saturday, January 31, 2015. This conference was called an “Access Summit” in recognition of the first such conference co-sponsored by the KDA focusing on Statewide Dental Access Issues held on May 24-25, 2001. Over 70 people attended including front-line dental providers, representatives from the UL School of Dentistry and the UK College of Dentistry, leaders from the KDA, the program coordinator from Oral Health America, and other interested parties including physicians, nurses, social workers, and administrators from all over Kentucky. This report summarizes the proceedings of this conference, including providing recommendations from participants to address dental access issues in Kentucky.
The one day conference was divided into two sessions; an overview session in the morning, and a workgroup participatory session in the afternoon. In the morning the following subject matter experts spoke on their areas of expertise:
Dr. John Thompson, Former Executive Director KDA, and Editor, KDA TODAY spoke on “Overview of Access Issues in Kentucky”. Dr. Raynor Mullins, Professor and Chair of the KDA Medicaid Reform Committee of the KDA spoke on “Medicaid Update, the Affordable Care Act (ACA) and Pediatric Dentistry”. Dr. Bob Henry, Chief Dental Service, Dept. of Veterans Affairs and the Dental Director of Mission Lexington Dental Clinic spoke on “The Mission Lexington Dental Clinic (Adults)”. Dr. Pam Stein, Associate Professor and Associate Dean of Academic Affairs University of Kentucky College of Dentistry spoke on “Dental Access for Nursing Home and Geriatric Patients”. The final speaker was Ms. Lacey McNary, MSW, Policy Director, Kentucky Youth Advocates, and current President of the Kentucky Oral Health Coalition, who spoke on “The Kentucky Oral Health Coalition and its Role in Dental Access”.
The afternoon session was devoted to small group discussion and participation. All conference participants were split up into four breakout groups of approximately 20 people each, depending on their expressed interest. The following four breakout groups were led by the subject matter experts as follows:
Group A: Collaborating with Organizations to Effect Change
Dr. Thompson and Ms. McNary, Group Leaders. Recorder: Ms. Melissa Nathanson
Group B: Medicaid, ACA, and Children
Drs. Mullins and Ken Rich, Group Leaders. Recorder: Ms. Sandy Challman
Group C: The future of dental missions in Kentucky
Drs. Henry and Karl Lange, Group Leaders. Recorder: Mr. Huston Hastie
Group D: Nursing Home and Geriatric Dental Issues
Dr. Pam Stein, Group Leader. Recorder: Dr. Mike Mansfield
The remaining report will summarize the morning presentations and the afternoon recommendations developed in the four breakout groups.
Morning Presentations: Overview Sessions
Overview of Access Issues in Kentucky: Dr. John Thompson
Dr. Thompson began by giving a historical perspective on the Dental Access Problem in Kentucky. When the first Dental Access Summit was held in 2001 there was a problem; in 2008 when the U.S. was in a depression there was a dental access problem; and in 2014 the dental access problem blew up due to the Affordable Health Care Act and Kentucky’s Governor Steve Beshear’s decision to expand Medicaid and include adult dental services. In contrast to the ADA’s claim that “Dentistry is Healthcare that Works”, Dr. Thompson quoted Dr. Frank Catalanotto from the ADA who wrote “Why the ADA is wrong about access to Dental Care”, published in 2012 in ADA’s Frontline . In the article he states, “Most dentists come from middle to upper middle class families…They see the patients that come to their practice, and they think that everything is fine because those patients are getting care in their office. What they don’t see are the 100 million individuals that don’t have dental insurance. Even the ones that have Medicaid can’t get access because … reimbursement rates are so low.”
While it is generally agreed is that professionals should give something back to the public following the premise of Edmund Pellegrino, a medical ethicist who used the term “the moral aspects of professionalism” to explain philanthropic care. While it is important to give back to the public, it is also understood that professionals can’t build a practice or a system of care entirely on philanthropic care. “What we need is a system that has appropriate reimbursement for those who can’t afford it, a system that has education so patients can help prevent their own disease, and a system where dentists are rewarded for preventing disease rather than filling teeth.”
In an article published in the New York Times August 30, 2013, Catherine Saint Louis found that after reviewing national patient data from 2000 to 2008, hospitalizations for dental abscesses had increased by more than 40% (and caused possibly as many as 66 deaths). In addition, a PEW Charitable Trusts report estimated that preventable dental conditions including abscessed teeth were the primary reason for 830,590 emergency room visits in 2009 (a 16 percent increase form 2006).
In the 2014 November/December Issue of the KDA TODAY, Dr. Thompson asks the question: “When is the Right Time?” to expand Medicaid for adults in Kentucky. By all measures Kentucky is one of the unhealthiest states in the U.S. in regards to high rates of obesity, diabetes, hypertension, high tobacco usage and low exercise. Dentally, it is a state with high caries rates for children, significant periodontal disease in adults, and high edentulism rates in adults over 65 years of age. When Congress passed the Affordable Care Act (ACA) effective January 1, 2014, states had to decide what course of action it would take. In Kentucky it was an easy choice due to the current federal subsidized funding of Medicaid at the 69.9% and the promise of 100% federal funding for expansion and graduated to 90% in 2020 but with graduated decreases from 2017 to 2020.
KYNECT is the name of Kentucky’s Healthcare exchange with the byline of “Quality Health Coverage for every Kentuckian”. Statistics regarding Kentucky’s uninsured include:
· 640,000 estimated uninsured people in KY prior to the first open enrollment period, approximately 17.5% of the population under 65
· 308,000 potentially eligible for Medicaid under the new rules
· 332,000 potentially eligible for coverage through health benefit exchange
Kentucky’s under 65 population uninsured by Federal Poverty Level (FPL) are broken down as
follows: approximately 43% are less than 13% of the FPL; approximately 18% are between 139 and 399 FPL; and about 5% make over the 400 FPL. As of March 31, 2014 the enrollment numbers reported by KYNECT in Kentucky were:
· 1 out of every 12 Kentuckians, approximately 8% of the state’s population, have enrolled in coverage via KYNECT
· 370,829 Kentuckians are enrolled in new health coverage
· 293,802 have qualified for Medicaid coverage
· 77,027 have purchased private insurance
· 50% of all KYNECT enrollees are under the age of 35
· 20,628 have enrolled in stand-alone dental plans
· 1,588 small businesses have started applications for employee coverage; of those, 621 businesses have completed applications and are eligible to offer coverage to employees.
In summary, over 80% of eligible people are currently now enrolled or are eligible for Medicaid in Kentucky. Unlike other insurance plans that Dentists have chosen to ignore, or the comment “this too shall pass”, Dr. Thompson cautioned that this issue will not go away or solve itself.
The facts regarding Kentucky Dental Medicaid are as follows:
· The last adjustment to Kentucky Dental Medicaid Fee Schedule was in 2002. This adjustment took fees to 50% of UCR fee schedules in 2002.
· A 25% fee increase will NOT return fees to that level if made today.
· There has been an additional 10% reduction in those fees instituted by the MCOs.
· Administrative Costs (to appoint and follow) for patients has more than doubled
· The Kentucky Healthcare Exchange KYNECT has been phenomenally successful in adding 431,000 Medicaid eligible people
· Conversely, the dental Medicaid network is shrinking, due to low reimbursement rate, failed appointments, and unwillingness to practice preventive dentistry and a mind-set of entitlement among Medicaid participants.
In rural Kentucky, where dentists accept Medicaid and are practicing alone (solo), Medicaid is proving to be too costly for Dentists to keep. Based on a very typical business plan, a rural solo dentist can accommodate 25% of the practice being Medicaid based. This is based on the dental chair being filled for scheduled treatment the remaining 75% of the time. The Medicaid patient does not contribute to the profit of the practice. If all other chairs are filled, it will represent a net loss which means the other 75% of the practice will have to carry (pay for the remaining overhead and fees) Medicaid patients in the practice.
Kentucky’s rural economy has not recovered! KYNECT and the new Medicaid qualified have turned previous full fee patients into Medicaid fee patients. The percentage of Medicaid fee patients is now exceeding 40% of the rural solo dental practice (that accept Medicaid), and these practices are failing. A retiring dentist in a Medicaid practice now has no hope of selling the practice or having a new dentist replacement.
A second major issue has been the rising Dental Student debt! State funding support for dental schools has been cut 14 times in last 10 years. As a result, tuition has had to increase to maintain quality faculty and academic programs and curriculum. Tuition has increased over 110% during that same time period, increasing the average student debt to approximately $250,000. Dental graduates can no longer afford to go into Medicaid service areas and expect to repay their massive student debt. Lending is not available for upside down dental practices or non-profitable business plans.
How big is Kentucky Medicaid? In 2013, 1,004,607 people in Kentucky have enrolled, plus an additional 577,604 children. At a cost of $5.9 billion dollars, plus $145 million for KCHIP, enrollment of Kentuckians continues to increase. In 2014, another 470,000 have qualified for KY’s Medicaid and 308,000 (or more) are expected to enroll. Politically and administratively, the KYNECT program has been phenomenally successful. Unfortunately, for dentists who accept Medicaid, they are losing money on every new Medicaid patient seen, and this cannot be sustained indefinitely. One in four Kentuckians are now Medicaid eligible and Medicaid (among all the medical insurance companies) is the largest payer for Kentucky Health Care.
At the congressional level, there has always been the question of: “why is dentistry separate from medicine?” That distinction is becoming harder to sell as medicine continues to integrate with dentistry. Medicaid under the ACA, has created a new marketplace; the Health Exchanges, where consumers can demand information on quality as well as cost. Exchanges allow consumers to demand low cost for high quality. Dentists can no longer say “It’s someone else’s problem”. In the past, dentists might have said “I’ll protect my turf while “they” fix it. Today the ACA and the KY Adult Dental Medicaid changes have made the health care access issue, every dental provider’s problem in Kentucky.
Improvement of Oral Health and Access to Oral Health Service in Kentucky: Dr. Raynor Mullins
Dr. Mullins gave a comparison of how the state had changed since the last dental access summit held in 2001. Kentucky’s population has grown from 4,041,769 in 2000 to 4,640,916 in 2015. The number of practicing dentists has increased as well from 2,138 in 1998, to 2,511 in 2012. During this same period, the total Medicaid enrollment has increased even more.
Although these new enrollees are creating huge problems for the dental providers who rely primarily on private fee or insurance patients, Dr. Mullins reminded the group that the state had addressed difficult access issues before. In his presentation given in 2001, Dr. Mullins stated the access problems were just as bad. He stated, “The magnitude of the oral and general health disparities and dental access problem in Kentucky is enormous”… In 2001, Dr. Mullins suggested the following were the main issues:
· very high poverty levels, low education levels
· high numbers of special needs patients
· high rates of tobacco use, diabetes, coronary heart disease, obesity, stroke and low birth weight and premature babies
In addition, it was noted in the 2001 Dental Summit meeting that “good, accurate state-wide information on oral health and the oral health workforce is lacking (out-of-date).” The last Kentucky Oral Health Survey was done in 1987. “For state programs like Medicaid and KCHIP, dentist’s participation has been poor due to low reimbursement rates.” “High broken appointment rates for Medicaid patients are a big problem and already busy appointment schedules restrict available dental appointments for Medicaid and KCHIP patients”. A quote from May 24, 2001 states: “Kentucky’s Medicaid program is projecting major long-term budget shortfalls and is considering reimbursement and benefit reductions in all areas, including the optional adult dental benefit”. Dr. Mullins concluded in his report in the 2001 summit: “If you keep moving in the direction you’re going, you will end up where you are headed. I would submit to this summit, we are headed for disaster.”
In the 2001 Summit, five major oral health goals were proposed. In reviewing these goals, Dr. Mullins was surprised to find that all five of the goals had been achieved as of 2014 including:
1. Implement a strong oral health component into Kentucky’s new early childhood development program.
· KIDs NOW program developed in Frankfort, did just this.
2. Develop a state-wide collaborative private and public “Seal Kentucky Program.”
· This was done by provide sealants by the KDA at the Kentucky State Fair along with support from the UK and UL schools of dentistry.
3. Revise the Kentucky Dental Practice Act to permit general supervision of dental hygienists in both public programs and private dental practices.
· Public health department dental hygienists added in July, 2014.
4. Implement a collaborative safety-net dental program for high risk populations in Kentucky.
· Regional “Critical Dental Access Support Programs” “CDASP programs developed in Hazard, Morehead, Madisonville. In 2006, the Kentucky Oral Health Network (KOHN) was formed.
5. Plan and initiate a new collaborative Kentucky Oral Health Education Campaign
· State-wide Oral Health Literacy Campaign begun by KDHC
· Regional Oral Health Coalitions have begun
· Appalachian Rural Dental Education Partnership (ARDEP)
Dr. Mullins concluded that a whole new set of problems and issues have occurred in the decade following the 2001 Oral Health Summit.
Dr. Mullins suggested that based on these new problems and issues coming together at this time, it is symbolic of the “perfect storm”, especially for rural Kentucky. In 2001, Dr. Mullins referenced five big rocks which needed to be addressed to improve Kentucky’s dental access. In 2015, Dr. Mullins suggested three big oral health improvement boulders:
1. Improve oral health information
2. Improve Kentucky’s Medicaid Program
3. Develop a new Kentucky oral health workforce plan and policy
Boulder one: Oral Health Information. This boulder suggests that dentistry must be integrated fully into Kentucky’s Health Information/Quality Improvement Infrastructure. This includes dentistry needs to be involved in: The Kentucky Information Exchange (KHIE); new all payer claims data base (dental portals/patient registries); electronic records shared to “coordinate care”; incorporate evidence based dentistry; dental payment reforms; and outcomes assessment (NQA Quality measures).
Boulder two: Improve Kentucky Medicaid Program. Dr. Mullins stated that most dentists know and understand what needs to be done to improve KY’s Medicaid program: simplify administration; increase dental reimbursement levels to reasonable levels; coordinate patient care and improve patient compliance via education and outreach; make improvements in oral health literacy and personal and family behaviors, and make improvements in oral health knowledge and practices of other health professionals.
Boulder three: Develop a New Kentucky Oral Health Workforce Plan and Policies. Questions to ask include: How many dentists are needed for the dental workforce (generalists and specialists); how many dental auxiliaries (assistants, hygienists) are needed for the dental workforce; what are the dental enrollment levels for dental students (in-state versus out-of-state and dentist versus dentist auxiliary); scholarships/incentives for serving Medicaid/KCHIP populations and rural practice.
The relationship of these three “access boulders” will also be important: Medicaid/KCHIP, Dental Utilization, and Dental Workforce. The summary slide includes how the following four factors are related: access to care, oral health literacy, health outcomes (oral/general), and dental services outcomes and quality. The bottom line is that dentistry will need to demonstrate the value/added benefits of oral health for overall Health and Health Care delivery. Dentistry will need to show how improving oral health will lead to improved health outcomes and reduced medical care expenditures.
An important goal of the KDA and dental profession should be to increase engagement of a larger share of practicing dentists with the goal of improving access and quality for financially disadvantaged and special needs populations. In addition to dentists increasing engagement among their own profession, the dental profession will need to increase their engagement with other health care professionals to coordinate care.
An essential glue to hold the boulders together will be that of “collaboration”. Dentists must work more effectively together; both within our profession and with other health care professionals and state leaders to address the current access to dental care and workforce issues.
The Mission Lexington Dental Clinic (Adults): Dr. Robert Henry
Dr. Henry had five objectives of his presentation:
1. Meet a few patients of Mission Lexington (to understand what kind of patients are being served by this type of “free clinic”)
2. Discuss why Mission Lexington exists and how it came about in Lexington.
3. Understand what factors are needed to initiate a “mission” dental clinic to provide “free” dental care in a community.
4. Discuss funding issues and what costs are involved in beginning a mission dental clinic.
5. Understand why “free” dental clinics will need to change under the ACA in order to survive (and be able to continue to provide dental care for underserved people).
Patients of Mission Lexington (names have been changed)
Sherry was one of our first patients. At 49, she was referred from the UK College of Dentistry. After having an extraction for one tooth, she came to us because she couldn’t afford the cost of other extractions. At Mission Lexington, she had the remaining 12 upper teeth extracted, along with six posterior molars and premolars due to unrestorable caries. Her remaining lower anterior teeth were restored and upper dentures and lower partial were fabricated.
Lewis was 21 and a chronic Mountain Dew drinker with poor oral hygiene. Married with two children, Lewis had been a handyman doing painting and construction, but had no dental insurance. He wanted to enlist in the army, but the recruiter told him he would need to “get his teeth fixed” and then the army would talk to him. He had all 32 of his natural teeth extracted due to extensive and unrestorable caries at the Mission and dentures were fabricated. Lewis was then recruited by the Army, and is currently serving on Active Duty in Texas.
Shannon came to the Mission because she claims she had been in pain from her teeth for 12-15 years. At 34-years-old, she was unhappy about her appearance and ashamed of when she smiled. All 12 of her upper teeth were extracted, all lower teeth were restored and cleaned and an upper denture was fabricated. Today, Shannon is pleased with her smile and currently working in a stable job and is not ashamed to smile.
Bill is 53-years-old. He had 14 teeth “pulled in jail” and three teeth pulled at the Lexington Health Department. He was referred to the Mission to extract his remaining six teeth and “because we make dentures here”. After completing his extractions and dentures, today, Bill works in construction and as a janitor. He has volunteered at the Mission cleaning floors and doing maintenance.
Rob is 39-years-old and just recently got out of prison. He reports his teeth began hurting in 2002. He has severe periodontal disease, and he reported that he could not get dental care where he was. After extracting all but two teeth (which were used to hold a lower partial in place), Robbie had an upper denture and lower partial fabricated. Robbie could not get a job before his treatment. Now, he is employed as a truck driver and is very grateful the Mission was there to provide care which he could not afford otherwise. He is now in no pain and able to chew and eat with his new dentures.
Discuss why Mission Lexington exists and how it came about in Lexington.
Mission Lexington was founded in 2004 to help address the dental need in the Lexington Community. It also provided a way for dentists and dental providers who were members of the churches involved to provide outreach and service opportunities. By doing so, it gave these individuals an opportunity to witness and practice stewardship to the church in a unique way. Finally, it gave young students who were considering a career in the dental field the opportunity to volunteer to see if dentistry was a good fit for them.
Although other free or low cost dental clinics exist in Lexington, Mission Lexington is unique in that it was incorporated as a 501 C-3 nonprofit corporation with an interdenominational board. Currently, the board is made up of representatives from six churches in Lexington, but the founding three churches were: Calvary Baptist Church, Faith Lutheran Church, and Maxwell Street Presbyterian Church. The Mission Lexington Dental Clinic was founded on seven guiding principles (philosophy):
1. We would not accept Medicaid, as we did not want to compete with others that provided for these patients.
2. We would not treat children, because a better safety net exists in Lexington for children than for adults.
3. We would not become a low-cost denture clinic, as this was not to be our primary mission.
4. We would see the homeless and poor, those who were at or below the US federal poverty guidelines ($817/month for 1 person in 2004).
5. We would try and relieve pain/suffering as our primary dental goal, and to reduce E.R. dental visits to hospitals in our community.
6. We would try and incorporate the dental clinic as an educational site for pre-dental, dental, and graduate level students who wanted to provide “outreach” care.
7. We would try to become a model for inter-denominational cooperation to meet a fundamental need (dental care) in our community.
To qualify as a patient for Mission Lexington Dental Clinic a person must:
· be over 18 years of age,
· live in Lexington, Kentucky (Fayette County)
· have NO dental insurance (including NO Medicaid)
· Have an annual household income at or below $11,490 (2014 income for one person) OR be a current Mission Lexington MEDICAL CLINIC Patient. Mission Lexington began a Medical Clinic in 2009 and has seen over 1,100 patients and over 5,700 patient visits)
· Be willing (and able) to wait several months prior to the first appointment. (Note: we are not an emergency clinic).
Although incorporated as a free health care provider in 2004, the Mission Lexington Dental Clinic began seeing patients in June 2006. Currently, as of January 2014, the Mission Dental Clinic has seen 1,885 new patients and had a total of more than 8,200 dental visits. The number of patients requesting dental care has correspondingly increased every year with a currently wait list of approximately 950. The wait time before patients can be seen has also increased with the average time for a patient to be seen once placed on the wait list is nine months. The clinic is open between 25 and 40 hours a week, depending solely on when volunteer dentists sign up to work. With a current work force of about 30 dentist volunteers, dental hygienists, dental students, dental assistants, and several lab technicians, who all volunteer their time, the clinic primarily sees patients at night from 6-9 p.m. and on Friday and Saturday mornings.
The initial building cost for the Mission Lexington Dental Clinic was less than $36,000 for a three-operatory clinic in a building which was owned by the Calvary Baptist Church located on 317 S. Limestone Street. The cost was controlled through internal volunteers from the member churches volunteering their labor and expertise on weekends over two years to build and equip the mission. Corporations donated thousands of dollars, along with dentists from the community who gave freely to initially equip the Mission. In 2012, the Mission Lexington Medical and Dental Clinics purchased a new building located two streets away from the initial clinic on 230 S. Martin Luther King Jr. Drive, Lexington. This new clinic houses the Medical Clinic (three exam rooms and a lab), the Dental Clinic (six operatories, a dental lab, and extensive storage and sterilization areas, and most recently, Faith Pharmacy, a free clinic to provide basic medications for our patients.
As the patient activity and visits have increased, and the building and maintenance costs have risen, so have the operating costs. From the initial building and operating costs of less than $36,000 in 2006, projected operating costs for 2015 will approach $350,000, an increase of approximately 10X! The income sources for sustaining the Mission includes: private (37%), member churches (22%), City of Lexington Grants (16%), fundraising (12%), Central Baptist Hospital (9%), and denture fees (4%). It should be noted that the only charges passed on to patients for dental care provided are those for the lab fee for partial dentures and dentures. Initially, this charge was $100 for one partial or denture, and currently the charge is $175 for a single partial or denture. This fee is sometimes waived if patients have demonstrated significant hardship.
1. Understand what factors are needed to initiate a “mission” dental clinic to provide “free” dental care in a community.
1. A group of dedicated people who share a vision and are able to generate enthusiasm and support from their church and community. The clinic was built largely by church members converting a former dress shop owned by the church into a free health clinic.
2. Strong and consistent leadership. The Mission Lexington Founder served as the First Executive Director and was the former Associate Minister for Missions at Calvary Baptist Church. The Second and Current Mission Lexington Executive Director is a minister and provides strong leadership for the Mission Lexington Board of Directors.
3. Ability to raise money. The Board of Directors are responsible for setting the vision and direction of the Mission. In addition, they determine the budget and are responsible for raising money through public and private donors.
4. A paid dental clinic coordinator. The one person who provides continuity from day-to-day, week-to-week is the paid coordinator. The dental clinic coordinator takes all phone calls from patients (averages 20 per day), schedules patients, volunteer dentists, dental hygienists, and assistants, continually inventories supplies, instruments, and maintains dental equipment.
5. Dedicated volunteer dentists and support staff. Without volunteers, no one would be able to provide care. We are fortunate to live in an area where, not only community dentists support the mission, but also the Blue Grass Dental Society and the College of Dentistry which has been supportive with faculty, dental students, and pre-dental students. In addition the Dental Hygiene school faculty and students have provided volunteer support as well.
2. Discuss funding issues and what costs are involved in beginning a mission dental clinic.
How much money is needed depends on the goals of the clinic. Table 3 summarizes the costs involved in beginning and sustaining a mission “free” dental clinic
3. Understand why “free” dental clinics will need to change under the Affordable Care Act (ACA) in order to survive (and be able to continue to provide dental care for underserved people).
The ACA has changed eligibility for adult dental Medicaid in our state. Since enacted on January 1, 2014, the majority of Mission Lexington Dental Patients are now eligible for Medicaid. Previously, the Mission would not accept ANY patient who qualified for Medicaid, as several providers in the area, including the University of Kentucky, would and do accept Medicaid patients into their practice. In a recent survey done on a sample of 452 active Mission Lexington Dental patients seen since October over 90% of patients are either qualified for Medicaid, recently received Medicaid, or have Medicaid. Only about 8% of those surveyed do not qualify for adult dental Medicaid benefits.
If over 90% of Mission Lexington patients now qualify for Medicaid (and we do not take Medicaid because other clinics such as University of Kentucky Dental School does), then who will be left to be seen? Nationally, nearly a dozen “free” medical clinics have closed in the past two years, citing the federal health law (ACA) as a major reason. Closings have occurred in 28 states and Washington, D.C. which all expanded Medicaid (which is taken as a sign the law is reducing uninsured people). These closures have left pockets of uninsured people who are not covered by the law. This has been particularly hard on patients in those states that did not expand Medicaid.
Many of the 1,200 free and charity clinics nationally:
· Have struggled with a drop in funding because donors believe there is no longer a need for free or low-cost care in the wake of the ACA health care law
· In ML’s case for dental patients, 91.2% of patients NOW either have or qualify for Medicaid (and adult dental benefits: cleaning, fillings, extractions).
· In the past two years, donations to free and charity clinics nationally have dropped 20%. During that same time period, patient demand has risen 40%
· The paradox is that fewer dentists are taking Adult Medicaid for Dental due to the low reimbursement rates and limitations in treatment options (no dentures, partials, etc.)
Examples of ACA and effects on “free” clinics:
· Savanna Georgia: Community Health, closed Oct. 30 despite a waiting list of patients to be seen, due to funding problems largely due to a decline in donations
· Western Stark Free Clinic, Massillon, Ohio, closed December 2014 (after being open for 15 years) due to a 30% drop in patients because most are now eligible for Medicaid
· Community Clinic: Minneapolis, Minnesota opened in 1972, closed in August 2014. Visits had dropped 30% following health care law. “As soon as there was the perception of universal health care, the likelihood of receiving donations goes down”, said a lawyer who served on the board.
What can free clinics do in Kentucky, a state that has dramatically expanded Medicaid?
1. Accept Medicaid (what will this do to donors?)
AND perhaps ALSO OFFER free services to those who do not qualify (8.8% of those patients at ML).
2. Become a University of Kentucky or Louisville Dental School satellite clinic (with the notion of being a student focused clinic). Many patients who need treatment, and easier access to care.
3. Apply to become a Community Health Center. (may or may not receive funding)
4. Close or cut-back services. (Where will our patients go who need dental care?)
It is predicted that the effect of the ACA by 2023 will reduce the number of medically uninsured by 25 million according to a May 2013 report by the Congressional Budget Office. That will still leave 31 million Americans without health insurance. In dentistry providers are reluctant to take Medicaid due to poor reimbursement and the difficulty of submitting claims. The American Dental Association is advocating for Medicaid reform to improve the safety net. On the dental side, integrating oral with medical health care (Universal coverage) should be the goal.
In Part II of our Dental Access Summit Report, which will be featured in the May/June issue of KDA TODAY, the remaining morning Summit presentations will be reviewed. In the second half of Part II, the top recommendations to improve access issues in Kentucky from each of the four work groups will be outlined.
Save the Date
November 20, 2015 - Louisville, KY
Statewide Oral Health Summit