For those on Medicaid, it can be a struggle to find dental care in the Twin Ports
"Work from home is good," she said. "I have nobody to help me, no family if kids get sick. So they give me a machine to work with in my home."
Even with the job she's held for 11 years, she described herself as "low-income." Not long ago, Bekteshi, of
Bekteshi's kids lost their private practice dentist when she lost the health insurance she was buying through the state after her particular insurer couldn't agree on a contract with
"Everything changed," she said.
Of dentists and Medicaid, she found, "They don't like it; they don't accept it."
A
Local dentists and the state dental associations explained there is a valid reason for the aversion to Medicaid, namely some of the lowest reimbursement rates in the country. In
Because of the low return rates, dentists in the Twin Ports often don't enroll to accept Medicaid as a payment. The ones that do are mostly clinic-style providers set up with multiple dentists and a lineup of chairs so they can cost shift and spread their financial risk across many patients in the way medical doctors do.
For traditional dental offices -- solo practitioners operating a small business -- the return from Medicaid is so low in
"The answer to this is money," said Dr.
'A child can't decide'
When it comes to a person's dental care, a universal rule of two applies: brush at least twice a day and visit the dentist twice a year.
But for children who are underprivileged in the Twin Ports, a complimentary toothbrush and the polite reinforcement from a hygienist to brush their teeth isn't a sure thing. For some, routine trips to see the dentist don't happen at all.
Evidence from state dental associations, legislatures and health departments shows that children whose families are on free or low-cost health coverage can have a difficult time seeing a dentist. They're discouraged because of trouble they have finding private practice dentists enrolled to take payments from publically funded insurance programs, most prominently Medicaid.
In
In the Twin Ports, there is some confusion about exactly how many children face barriers to routine dental care. But related statistics and stories from the front lines tell of hundreds of children locally who experience life along a fine line between having dental care and none at all.
"Many of those are kids who might have gone without dental care if we weren't here to serve," said CEO
The confluence of few providers to serve what is a growing roster of Medicaid-enrolled children has created what is described within the industry and state health departments as an "access to care" issue. Children who are underprivileged bottleneck into only a few dental health providers. When it comes to routine care, they can be made to endure months-long waiting lists. Or their families can pay cash to see dentists who aren't enrolled to accept Medicaid. Missing an appointment to a private dentist comes with opportunity costs for families experiencing poverty, sources said, because for them a no-show under any circumstances usually means there's no welcome back.
"A child can't decide if they go to the dentist or not," said health manager
The Family Forum Head Start Program serves families with the lowest incomes first. In
For some children it can be their only interaction with dentistry. But it's also not ideal. Majerle said she's seen it where a child was diagnosed with an abscessed tooth and their family given a referral for corrective care, only to have the same child's abscess reviewed again the next time the health center came to
"There is a problem with access to care -- it is real and I can honestly tell you we are working on it tirelessly," said Nelson, the ranking member of the local branch of the
Nelson is like most of his peers locally in that he does not accept Medicaid. His shop is what a person thinks of as a traditional dental office -- a small business owned by a solo practicing dentist and staffed by a small team of experts. It's a model currently not well-equipped to handle some of the
But the low reimbursement rates set by the
"There are ethical concerns," Nelson said of the access to care issue. "But there are business concerns, too. You can't see anybody if you can't keep the doors open."
A working model
Locally, it's clinic-style dental offices that are equipped to field children in poverty. Shops such as the
Eversmiles' Dr.
"My training was I serve the hardest children to treat," he said.
Going back to the start of his career in 1985, he used to see 12 percent of his patients on Medicaid. After 23 years in
"We're seeing more and more children on government-funded insurance programs," he said. "It's getting worse not better, and I think we'll see (the trend) continue."
As currently situated, Bruzek believes the Twin Ports is serving children as well as could be expected within a 60-mile radius. Waiting lists for routine care are part of the deal, he said.
"But if I have a child with a facial infection, swollen neck or something like that," he said, "I'll get them in tomorrow."
Patterson, the CEO at the
Federally qualified health centers such as
"We provide quality care and cost-effective care," Patterson said.
The health center is where Bekteshi ended up taking her children for dental care.
"They take good care of us," she said. "When they said, 'We accept Medicaid here,' I made check-up appointments."
Solutions ahead?
Nelson and sources from the dental associations in
The
"My members want to see Medicaid patients," said
Many dentists give back by working pro bono in their own offices and at auditorium-style events designed to bring in large volumes of people who are poor and undertreated. A two-day Mission of Mercy event in 2015 at the
Commercially, the industry is shifting toward a solution with the rise of direct service organizations. They're dental operations that break from the traditional model for the way an owner, who may or may not be a dentist, operates multiple practices in a group-based fashion, Nelson said.
But at a time when the social safety net is being re-examined in
"Out of a total medical/dental yearly budget, at least for
For many years, Nelson said, he accepted Medicaid at his practice. He's considering doing so again. His exposure to the access to care issue from his trustee position in the state dental association weighs on him.
"When you're off on your own, you're in your own little world and you make your own decisions," he said. "I may be changing my decision. I'm older now. Things are getting paid for. Even though I have given back in many ways internally within our practice, it may be time for me to look at that a little closer."
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