KDA Today

KDA Today

For Immediate Release

Date: Oct 15th, 2015
Contact: Dr. Beverly A. Largent
Phone: 800-292-1855
Email: info@kyda.org

Oral Health Literacy as a Primary Goal and Not an Afterthought

Much has been written about Kentucky’s Medicaid expansion. Governor Steve Beshear waited for the last minute to declare expansion by executive order, but made up for any foot dragging by creating one of the most outstanding state web sites for accessing the advantages of the ACA. Titled, kynect, this is a state-based marketplace where residents have on line access to affordable insurance. The participation rate for children in Kentucky is just above 90% (Medicaid.gov). In fact, the program was much more utilized than expected. The state predicted they would add 147,634 new persons to the Medicaid rolls. In reality 310,000 persons were enrolled in the first year, more than doubling the expected enrollment. To date 403, 125 Kentuckians have enrolled in health care coverage through Medicaid, or one in four citizens of Kentucky. (http://governor.ky.gov/healthierky/) Expansion costs are covered by the Federal Government for the first three years at 100% starting in 2014. Federal funding will gradually decrease to 90% by 2020, and the state will gradually require more funding for the program. Some estimates put this taxpayer supported cost at $864 million through 2022. (www.heritage.org)

Another positive aspect of Medicaid Expansion touted by the Beshear administration is reflected in the 2015 Deloitte Consulting Report and states that Medicaid Expansion will add 40,000 jobs and $30 billion to the state’s economy through 2021, and will generate a net positive impact of $820 million to state and local governments. (http://www.kyforward.com/kentuckys-medicaid-expansion-40000-jobs-30-billion-economic-impact-report-shows/)

kynect can also help families obtain subsidies for payment of their insurance costs. The Kentucky Government web site has a help guide for families to determine if they are eligible for assistance. For a family of four, the upper income limit for assistance is a yearly income of $94,000. The Department of Numbers (www.deptofnumbers.com) lists the real median household income in Kentucky for 2013 at $43,399. The Department of Numbers does not list a household size, but the disparity in the real median household income and the upper income limit for insurance payment subsidy does offer serious food for thought.

What does all this mean to the practicing dentist and the potential patient? The KDA Medicaid workgroup has identified many issues with the current program and its expansion. For the dentist, low reimbursement, repeated broken and missed appointments and overwhelming patient needs are paramount. For the patient, finding a provider is not an easy task. Piled on to the task of finding a provider is the process of randomly assigning an MCO to eligible patients. This can easily result in four children in the same family having four different insurance plans. This seems cruel treatment of people who already have difficulty using sometimes complicated plans. Dentists in the Medicaid workgroup report overwhelming unmet needs of the adult patient. On the best workday of the week, dentistry can be challenging. It is reasonable that dentists opt not to be providers. To accept patients at a low level of reimbursement can be dealt with. Even gross abuse of the dentist’s time can sometimes be overlooked. Add the additional stress of making ethical decisions for the devastated mouths of patients who can come 12 times a year and are limited by available procedures is too much to expect of anyone.

Events in the past few weeks (and years) have caused me to question my professional life decisions. I have been a Medicaid provider for all but nine months of 31 years of practice. I can count a few, very rewarding experiences where I have truly made a difference in the life of a child and his family. Only last week, a mother who was visiting my office with her four-year-old looked me in the eye and stated that I had saved her life. As a 13-year-old she had been utterly neglected. Although I do not recall all of the situation, she stated that I reported her plight to social services, intervened in the family court system, and she was removed from her parent’s home. It is doubtful that dental neglect was the greatest of her problems. Her foster parents are now grandparents to her child, and she texted them a photograph of the child in my dental chair.
On most days I am quenching the flames of neglect inflicted on small children either through ignorance or poor judgement related to drug use by the caregiver. I often see caregivers who are great grandparents or other older relatives who are aged and tired and incapable of the rigors of raising good citizens. A particular great uncle of a three and five-year-old made a lasting impression on me when he asked if the cavity holes would grow together. This uncle had no conception of regular tooth brushing for children (or, from the looks of things for adults). My suspicion is that he was overwhelmed with feeding the children, and providing shelter. If my suspicions are indeed true, this still does not account for the complete lack of knowledge of basic oral health and oral health care. Parents and caregivers who bring children with visible decay don’t benefit much from demonstrated tooth brushing instructions, disclosing plaque (what is plaque?), and diet counseling. They are in a very stressful and guilt ridden circumstance. In general, the parents I see feel they have no control over their child’s dietary habits or their tooth brushing habits. I often ask who buys the candy for the family. It is interesting to watch the reaction when the parent understands that they are the responsible party. Obviously, if there is a devastating backlog of untreated dental disease in the adult population, many, many people have missed the message about basic preventive dentistry and daily oral health care.

No matter how many people are on the Medicaid rolls, or how many citizens receive subsidies for their insurance costs, the dental needs of the State of Kentucky will never be met. Until all citizens have a basic oral health literacy, we are fighting a losing battle.

Fortunately, in Kentucky, we have the Public Health Hygienist who can impact school-aged children through cleanings, fluoride treatments, sealants and oral health instructions. Unfortunately, we have not been forward thinking enough and base the success of this program on the number of children who have had procedures completed. Without a doubt, the program has to be self-sustaining and numbers are important. Perhaps the greatest benefit of the PPH is their ability to influence the next generation and raise the level of oral health literacy, so that the dental needs of Kentuckians are not so devastating. To create any change, increased oral health literacy has to be the primary goal, not an afterthought, squeezed in between setting up and breaking down portable equipment. If that can happen, the numbers of sealants placed, or the numbers of kids with a fluoride treatment becomes irrelevant. We hold the answer, if only we can use it.

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