Medicaid payments too low, expert says
Health officials have made strides in getting low-income kids in Spokane County to the dentist, but regular dental care remains beyond the reach of many adults.
More than 30 percent of the county’s adults have lost a tooth to decay, according to the Spokane Regional Health District. Emergency room visits related to tooth pain are increasing. And even low-income adults who have insurance have trouble getting in to see a dentist because many don’t accept Medicaid reimbursements.
“Every health care assessment in Spokane County over the last 20 to 30 years has identified dental needs as a high priority. But we haven’t been able to move the bar for adults,” said Dr. Jim Sledge, a member of the Washington state Board of Health and a retired Spokane dentist.
At a Thursday symposium, Sledge outlined the state’s strategies for reducing cavity rates and improving oral health across Washington. Fluoridation of public drinking water and higher Medicaid reimbursements are both on the list.
Nearly 40 percent of state residents on public water supplies don’t have fluoridated water.
Fluoridation “really is a health-equity issue,” Sledge said. “Even if a person doesn’t have access to a dentist, drinking fluoridated water still bumps up their protection by 25 percent. The science is very clear: It’s effective and safe.”
Despite decades of research demonstrating the benefits of fluoridated water in preventing tooth decay, it remains a tough sell in Spokane. Voters turned down fluoridation initiatives in 1969, 1984 and 2000.
“We are one of the only cities of our size not to be fluoridated,” said Antony Chiang, executive director for the Empire Health Foundation, one of the symposium’s sponsors. “I think there’s an opportunity for this community to consider a change.”
Increasing the state’s reimbursement for Medicaid patients also would remove barriers to dental care, Sledge said. Current payments only cover about 28 percent of the cost of an adult dentist visit.
“It’s unrealistic to expect private-practice dentists to subsidize what the state should be doing,” Sledge said.
A program launched in Spokane last summer has been successful in helping people who frequent emergency rooms for toothaches to find dentists willing treat them.
“The No. 1 reason across Washington that uninsured adults visit ERs is dental complaints,” said Diane Oakes, deputy director for the Washington Dental Service Foundation. “It’s much better to get them into a dental clinic.”
Some of the people in the program had been to hospital emergency rooms 10 times for tooth pain, said Karen Davis, the program’s manager. While they were treated for pain and infections, the underlying problems weren’t addressed.
Davis calls dentists’ offices to see if they would be willing to take a few Medicaid patients. She also works with patients to make sure they have transportation and don’t blow off appointments.
The program is a cooperative effort between Providence’s Sacred Heart Medical Center and Holy Family Hospital, Washington Dental Service Foundation and Better Health Together, a subsidiary of Empire Health Foundation.
More than 1,000 people have been referred to the program since last July, and 1,400 dental appointments have taken place. But the need for dentists willing to see Medicaid patients is much greater, Davis said.