Seven of 10 poor children in Connecticut who are eligible for government-paid dental appointments aren’t getting them, according to a report released Thursday by the Connecticut Health Foundation and the Children’s Fund of Connecticut.
That means tens of thousands of poor Connecticut children don’t receive the care needed to prevent tooth decay and other potentially serious oral health problems, said Dr. Burton Edelstein, a dentist formerly of New London who co-authored the report.
Nationally, millions of poor children with untreated dental disease cannot “sleep, eat a meal or attend school” because of pain, said Edelstein, an associate professor of dentistry and public health at Columbia University and founder of the Children’s Dental Health project.
The report said that a 1998 state survey found that 40 percent of Connecticut’s second-graders had untreated tooth decay. But in 1999, fewer than 12 percent of children enrolled in the state’s Medicaid program were treated for dental disease. That same year, 71 percent of children covered by Medicaid did not visit a dentist at all.
Altogether, more than 185,000 children and adolescents are covered by the state’s HUSKY program, or the Healthcare for Uninsured Kids and Youth program – more than half of them through Medicaid.
“This is the first report to recognize the magnitude of the problem,” said Dr. James J. Crall, former professor at the University of Connecticut School of Dental Medicine and now director of Columbia University’s Oral Health Disparities Policy Center.
Edelstein and others who attended a press conference at the state Capitol cited several reasons why so many poor children do not get good dental care.
Very few dentists practice in poor neighborhoods and even fewer accept payment from Medicaid, which reimburses dentists at less than half the average price charged by dentists in Connecticut for many common procedures.
The report said that only 100 dentists – less than 4 percent of the dentists practicing in the state – regularly accept patients covered by Medicaid. Only 18 percent of the state’s dentists practice in five major urban areas – Hartford, New Britain, New Haven, Waterbury and Bridgeport – where about half of the children covered by Medicaid live. At the few clinics that do serve the poor, it can take months to get a dental appointment, the report said.
And dentists have little incentive to sign up to take poor patients because reimbursements do not cover costs, Crall and Edelstein said.
For instance, Medicaid in Connecticut pays dentists only $21.90 for a comprehensive oral exam for a child, while the average fee charged by dentists in the Hartford area for the same service is $54.
Two years ago, advocates for the poor sued the state Department of Social Services, charging that Connecticut has not lived up to laws requiring states to provide Medicaid beneficiaries access to the same level of health care as the general population. The case is pending.
The threat of a similar lawsuit in 1993 prompted the last substantial increase in dental reimbursement fees in Connecticut, Crall said.
The state public health commissioner, Dr. Joxel Garcia, agreed that many state residents do not get proper dental care. He noted that when he was a practicing OB-GYN, he often had to postpone needed procedures for his patients because of complications resulting from poor dental health. Garcia said that the state this year has $2.3 million in approved bond money to expand dental care services at community health centers, school clinics and other facilities.
Crall said Medicaid reimbursements need to be high enough to attract more dentists willing to care for poor patients. He also said more outreach needs to be done to make sure parents know their children should have regular dental checkups and where they can get subsidized dental care.