Commentaries are opinion pieces contributed by readers and newsmakers. VTDigger strives to publish a variety of views from a broad range of Vermonters. Commentaries give voice to community members and do not represent VTDigger’s views. To submit a commentary, follow the instructions here.
This commentary is by Mike Fisher, the state government’s chief health care advocate.
Have you had trouble getting dental care lately? If so, you’re not alone. Vermonters with low incomes, in particular, face a crisis in access to oral health care.
Thousands of Medicaid patients in Vermont struggle to find a dentist who accepts their insurance. For those who are lucky enough to find a provider, the next step can be even harder — deciding what needed services to get now, and what must wait until next year. That is because, except for pregnant adults and children, Medicaid limits dental coverage to two annual preventive visits and caps additional services at $1,000.
Medicaid won’t pay for dental services above this amount, even if they are medically necessary.
Hundreds of Vermonters call the Health Care Advocate HelpLine every month with questions about health insurance and how to access care. Dental access is one of the most common areas of concern that we hear about. Vermonters who experience these issues can lead to some of our most distressing calls.
Many people are in pain that is impacting their ability to work or get adequate nutrition. Provider shortages and the benefit cap limit the resources we can offer these individuals. Many of these clients need immediate care. They struggle to find a provider who will accept their insurance and will face financial barriers if they can get care.
Dental health is a critical component of primary care, but preventive care is inaccessible for many, due to long waitlists and provider shortages.
Hoping to incentivize more dentists to take on Medicaid patients, the governor has proposed to increase the Medicaid dental reimbursement rate from 50% to 75% of the commercial rate.
Joanne Puente, a dental hygienist and oral health case manager who serves low-income patients at the People’s Health and Wellness Clinic in Barre, thinks this is a great idea and is desperately needed.
She reports, “So many dentists do not accept Medicaid patients because the current reimbursement barely covers the operating costs for the procedures and sometimes doesn’t even cover the costs. Usually, the dentist and dental assistants and hygienists end up essentially ‘donating’ their time.” Many providers choose to not accept Medicaid patients for these reasons.
Increasing the Medicaid dental reimbursement rate to 75% of the private insurance rate is critical to incentivizing more dentists to become Medicaid providers. But provider participation should not come at a cost to patient access. In fact, increasing the dental reimbursement rate without also increasing the Medicaid dental cap will further limit patients’ access to care.
If Vermont increases the reimbursement rate for services without also increasing the Medicaid dental cap for individuals, we will devalue the current $1,000 dental benefit for members. In other words, Medicaid beneficiaries won’t be able to buy as many dental services.
The Office of the Health Care Advocate supports increasing the Medicaid dental reimbursement rate and removing the Medicaid dental cap for all adults.
Eliminating the dental cap would help alleviate access to care issues and mitigate the amount of time a patient experiences dental pain. Puente confirms that dental professionals also struggle with the limitations of the current dental cap and the ramifications this has on patients’ physical and emotional health.
“Many Medicaid patients need more than $1,000 worth of dental work,” Puente says. “About half of my patients are 50 years old or younger. Many of them have not received any dental care since they were kids. Many of them are recovering from alcohol and substance use (suboxone usually destroys teeth).
“Many of the women are relationship abuse survivors. They are trying to get their lives back together, but they are so embarrassed by their dental appearance. They are ashamed to apply for jobs, embarrassed to be with family and friends. They also have medical and dietary issues because of their dental issues. And the medical and dietary issues are even worse for the folks who are 50 years or older.”
Grace Winslow, a community advocate in Bennington, echoes the need for increased dental coverage for Medicaid beneficiaries. Additionally, she brings attention to the health equity issues patients with limited English proficiency face when trying to access care after they reach the dental limit.
“I’ve assisted with applications for dental vouchers for extractions after meeting the $1,000 cap and know from that experience that the application is complicated for someone who has a limited command of English, which can delay necessary dental work,” Winslow says.
Help the Office of the Health Care Advocate bring attention to this critical issue by contacting your state representatives and senators, members of the House Committee on Health Care, the Senate Committee on Health and Welfare, and the Governor’s Office. Tell them to remove the Medicaid dental cap for all adults.
This step will help mitigate our oral health crisis by contributing to provider sustainability while also enabling patients to get the care they need when they need it.
