Miami Herald, April 5, 2008: Fla. budget problem: how to make sure poor kids can see a dentist
By DAVID ROYSE
If a poor child in the capital city needs serious dental work, his family will probably have to drive several hours. Even in this city of more than 150,000 people, there aren’t any pediatric dentistry specialists who participate in the state Medicaid program for the poor.
The family’s best bet might be the University of Florida clinic more than two hours away in Gainesville. The wait will be a while, though, probably at least a month, health officials and dentists say. So they might try the closest big city, Jacksonville. It’s a little farther, but with nearly a million people, it has lots of dentists.
But even there, it would take some time before the child could get in to see someone who specializes in procedures for children: root canals, extracting seriously damaged teeth and surgery only done by pediatric dental specialists. There are only two or three pediatric dentists in all of Duval County who accept Medicaid.
This is the real-world problem behind part of the debate in the Capitol over the Medicaid budget.
Dentists say the reason so few of them accept Medicaid is that the government simply doesn’t pay enough. Most would get about three times as much for treating patients with private insurance. The last time the Legislature increased what dentists are paid to treat poor people: nearly two decades ago.
Statewide, there is one dentist for every 10,000 Medicaid-eligible children.
That means the few who do accept Medicaid are busy – and difficult to get in to see.
“We’re right now booking new patients three and four months out,” said Dr. Raymond Klein, one of the few pediatric dentists in Jacksonville who accepts Medicaid patients. “There’s just not enough people who can afford to provide this service.”
There are family dentists who may accept Medicaid patients, and there are county health outreach programs, like Leon County’s Molar Express, a program that provides routine care for some older children. But most of those dentists only do routine procedures.
In some cases, not getting care can be very serious. Last year, Deamonte Driver, a 12-year-old boy in Maryland whose family’s Medicaid coverage had lapsed, died after bacteria from an untreated tooth abscess spread to his brain. A routine tooth extraction may have saved him – but he couldn’t get in quickly enough to see a Medicaid oral surgeon.
Federal law says Medicaid patients are supposed to get the same access to care as people with private insurance. They don’t in Florida, said Klein, at least when it comes to children with oral health needs.
The two men in charge of writing the health care budget in the state Legislature are both keenly aware that Medicaid doesn’t pay enough to dentists – or for that matter doctors, either.
“Ronald Reagan was president the last time they got an increase,” laments Rep. Aaron Bean, a Fernandina Beach Republican and chairman of the House Healthcare Council, which writes the chamber’s health care budget.
Both Bean and his counterpart, Sen. Durell Peaden, R-Crestview, have said they had hoped this year would be the one they might increase Medicaid payments to dentists and doctors. That’s not easy – the Legislature is cutting the state budget because of a shortage of tax money coming in.
Health care is getting some of the biggest cuts as lawmakers put the finishing touches on the spending plan. The Senate and House are expected to vote on their budgets in the next few weeks and then will work out the differences later this month.
While the budget is still being crafted, Bean may have figured out a way to raise the rates a bit. The House plan would dip into money from the state’s 1997 settlement of a lawsuit against tobacco companies to increase Medicaid reimbursement rates. But spending that money for Medicaid means something else probably gets cut.
So far, the Senate budget doesn’t include an increase in Medicaid reimbursement rates.
“We just didn’t have the money,” Peaden said.
But in this year of budget cutting, at least they wouldn’t lose any money in the Senate bill.
Peaden, who is a retired doctor from the Panhandle, isn’t happy about the situation. The lack of access to quality health care in Medicaid is a particularly big problem in poor, rural areas like some of those he represents.
Peaden said he was moved by a recent examination of dental needs in which dental clinic workers said it was obvious which patients were from poor areas.
“They could almost recognize what county they were from by looking in their mouth,” said Peaden, R-Crestview. “That’s just not right.”
Peaden has tried to mitigate the problem by looking for ways to secure more money for dental care through the county health system, something the local health department has done in Jacksonville, too.
But the general dentists who work there aren’t trained to handle the most serious oral health problems, said Klein, the Jacksonville pediatric dentist. And there’s no one for county health department dentists to refer those patients to.
“In Duval County, there’s no orthodontists, there’s no endodontists, there’s no oral surgeons,” who take Medicaid, Klein said.
It’s going to get worse soon, unless the money gets better.
Klein noted that he and the one other pediatric dentist he knows in Jacksonville who accept Medicaid are both about 70 years old.
“We’re not going to be around here much longer,” Klein said. “Then you’re going to have 60,000 kids in Duval County who are going to have nobody to go to.”