Medicaid & Access to Dental Services

The U.S. healthcare system is the most costly compared to any other developed country and yet statistics describing our infant mortality rates, rates of disease and length of life are rather grim. Americans are receiving average to poor health care outcomes while paying twice as much as others living in the developed world.

As a BadgerCare Plus Outreach Specialist, I witness firsthand how healthcare reform could greatly benefit members I work with everyday. Imagine telling a single working mother that the only way she is able to obtain regular dental care is by driving over two hours one way to receive care, or listening to a member describe how his oral health pain became so severe that he extracted his own tooth with everyday tools laying around his house, all without anesthesia. While the Medicaid program in Wisconsin has been touted as one of the best, there are also many gaps, sadly due to financial issues. Members of BadgerCare Plus receive two cards once they have been enrolled in the program: one is their HMO card stating which HMO they are a part of and the other is the ForwardHealth card which is what members use for prescriptions, chiropractic care and dental services. However, when BadgerCare Plus members call the long list of dentists in their community, they hear a repetition of “no, we do not accept the ForwardHealth card,” leaving many Medicaid members without regular dental care for extended periods of time until emergency services are demanded due to pain, infections and reduced quality of life. Oral health care is extremely important for children, pregnant women and adults alike, all across the life span for many reasons. According to the National Maternal and Child Oral Health Resource Center, individuals from low income families face a twelve times higher rate of missing school or work due to dental problems compared to those from families with higher incomes. Early tooth loss caused by tooth decay may result in impaired speech development, absence from and difficulty concentrating in school, and decreased mental and social well being at school all of which in turn negatively affects the child’s self esteem and success later in life. In addition, a child who is experiencing dental pain or missing teeth may have to limit their food choices due to chewing problems which can result in nutritionally inadequate diets. It is also extremely necessary for pregnant women to receive regular dental care as pregnant women experience increased hormone levels making them more susceptible to oral infections which may result in pregnancy complications. There are several dental issues that pregnant women are more prone to develop including periodontal disease, pregnancy tumors, and pregnancy gingivitis.

The goal of BadgerCare Plus was to guarantee 98% of Wisconsin children health insurance, however if the oral healthcare needs are being unmet by a large number of Medicaid members, has the state of Wisconsin really fulfilled that need? Serious healthcare reform must take place in order to solve this dental access issue for BadgerCare Plus members. While it is true that some communities have attempted to combat the issue by establishing free or reduced price dental clinics, those clinics are forced to install parameters stating they will see only children under the age of 12 or emergency dental issues only otherwise the clinics would be flooded with individuals. One solution to the problem would be to increase the Medicaid payout to dentists. Currently the Medicaid rate for dental health care is 34 cents to the dollar, the reason dentists refuse Medicaid patients. Dentists do not want to perform a service for which they are underpaid compared to commercial HMO members. However, with the state of Wisconsin’s budget, finding extra money to dole over is not a very likely happenstance. Another solution would be for the state to mandate that every practicing dentist in the state has to see at least 10 Medicaid patients – that would greatly help to solve the problem.

The need for oral health care is the most prevalent unmet need among children and adolescents. A state Medicaid program targeting children and their caregivers that cannot guarantee dental services provides grossly inadequate services to its members.