Legislative preview: Dental care: The overlooked health care problem

January 6, 2019

It’s an overshadowed facet of the health care debate. But when the Minnesota Legislature convenes next week to kick off the 2019 session, legislators are expected to tackle what some describe as a growing public health concern: Dental care.

Officials say the problem can be measured in the $50 million spent each year on hospital emergency room services treating people with dental problems.

“It’s a huge public health issue. It’s one that is more solvable than some other health care issues, because dental care is relatively inexpensive,” said DFL state Rep. Tina Liebling, chairwoman of the House Health and Human Services Policy division.

Liebling said one of her personal goals is creating a state in which not one child has dental disease.

Legislators and dental experts say the problem is rooted in the low reimbursement rate paid to dentists by the state to treat patients in public programs. Minnesota’s rock-bottom ranking — 49th out of 50 in the country — means dentists get only 27 percent of the commercial rate they charge insured customers.

That’s led to a shrinking number of dentists who are accepting patients on Medical Assistance. That, in turn, means less access to dental care for low-income families and their children. There is not one dentist in Fillmore County, officials says, that sees children on public assistance.

“You would think Minnesota, being such a progressive state in general, would be one of the better places to get access to dental care,” said Karen Kleinhans, chief operating officer of Community Dental Care, a clinic that serves low-income families. “But because reimbursement rates are so much lower in the state, it’s just harder to get access.”

In 2009, the Legislature narrowed the benefit set for adults on public programs. One of the stripped-out benefits was a procedure known as scaling and root planning, a deep cleaning of the teeth and gums for people who have avoided the dentist’s office for a while.

The situation creates its own perverse incentives. A person without medical insurance can go to an emergency room and get treated for a throbbing toothache, because turning them away is against the law.

In the end, the patient might get an antibiotic to ease the pain, but the underlying problem won’t get treated.

Yet that same person can search in vain for a dentist, because “there are just not enough dental providers who are willing to take care of the large number of Medical Assistance (patients),” Kleinhans said.

The problem is compounded by the fact that even when people do have access, they fail to see a dentist anyway.

In 2015, there were 33,545 people in Olmsted County enrolled in state health care programs such as Medical Assistance or MinnesotaCare. Of those, only 30 percent received any dental services. That means that more than 23,000 county residents eligible for state-supported dental care were not receiving any.

About half of those residents were children. Tooth decay is the No. 1 reported reason children miss school, according to the Minnesota Department of Health.

Experts say poor teeth can have a wide-ranging impact on a person’s life. It can affect a person’s social interactions and their job prospects. It can affect one’s self-confidence. In more serious cases, dental disease can adversely affect a person’s health and worsen conditions such as diabetes and cardiac disease.

Community dental clinics have stepped in to address part of the problem. Inspired and founded by Dr. Vacharee Peterson, a Thailand immigrant, the clinics were created to serve new immigrants and people of all cultures and races in need of dental care. Community Dental Care has two clinics in Rochester and three in the Twin Cities.

In 2018, Community Dental Care served 54,000 patients statewide, including 8,000 in Rochester, Kleinhans said.

The patients who walk through Community Dental Care’s doors for the first time can be people who haven’t seen a dentist in years, if not decades. They are treated for gum disease and cavities and undergo procedures such a root canals, extractions, implants and dentures.

“We do almost everything,” Kleinhans said.

Dental experts are advocating for a higher Medicaid reimbursement rate and the restoration of some oral health benefits that were taken away in 2009.

Liebling, who by virtue of her committee chairmanship is expected to play a big role in the health care debate, said she hopes to make dental care a focus of her committee.

“I would really like to figure out how we can make it possible for everybody in the state to get the basic dental care they need to have healthy teeth,” Liebling said.

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