Oral-health experts agree on need for higher Medicaid payments, disagree on need for different kinds of dental care providers

Attendees at the meeting to update Kentucky's Strategic Plan
for Oral Health hear top priorities developed by workgroups.

By Melissa Patrick
Kentucky Health News

Kentucky needs to increase Medicaid reimbursement payments for oral health providers if it expects more of them to practice in the under-served areas of the state.

That was a consensus of the 130 dental advocates and stakeholders who came to Lexington May 31 and June 1 to help the state Department of Public Health's update the its Strategic Plan for Oral Health. The last strategic plan was done in 2006.

Deputy Health Secretary Tim Feeley, whose wife, Sue Feeley, is a practicing dentist, agreed that reimbursement rates are too low. "The Medicaid reimbursement rate for dental is so low that in many places it doesn't cover your fixed costs . . . so we have to work on the reimbursement rates," he said.

M. Raynor Mullins, professor emeritus at the University of Kentucky College of Dentistry, noted that fewer than one in four Kentucky dentists take Medicaid in any meaningful way. He also called for improving Medicaid reimbursement rates. "If we are going to address oral health in the state of Kentucky, we are going to have to figure out how to solve that issue," he said.

Mullins said a "solid reimbursement model" that supports all providers would resolve concerns among dentists about competition from mid-level providers, who he and other speakers said should be given more authority, to increase access to oral-health care.

M. Raynor Mullins

"I'd flood the market with dental auxiliaries. I'd have a public health hygienist in every county in Kentucky. I'd add [dental] therapists to the workforce. I'd add community dental health coordinators," said Mullins, who worked in public-health dentistry for more than 50 years. "We need every possible option in our tool box. We may not need them in every community, but in some communities we need them."

Attendees overwhelmingly endorsed expanding the role of public-health hygienists, who can already independently provide some preventive services, like applying dental sealants or fluoride treatments, in limited settings.

Both keynote speakers said dental therapists should be added to the state's oral-health team to increase access to care, but none of the eight work groups tasked with developing strategies mentioned this as a solution to the state's oral-health issues.

Dental therapists are midlevel dental-care providers who are similar to physician assistants in medicine. They are able to provide both preventive and restorative care, like filling cavities.

Larry Hill, the executive director of the American Association of Community Dental Programs, also recommended using therapists, though he too noted that a better reimbursement model is necessary.

"If you look at most of the dental therapy models, you are going to find that the evidence says that they provide high-quality, cost-effective care," said Hill, who was dental director for the Cincinnati Health Department for 30 years and the director of a non-profit dental agency for 24 years. He added that there is no evidence to support opponents claims that dental therapists are "under-trained, unsupervised and dangerous."

The Kentucky Dental Association, along with the American Dental Association, oppose adding this new category of providers to dentistry because they say there are enough dentists to fill the existing need and evidence does not support that therapists increase access to care at a lower cost.

"Right now we do not have a shortage of dentists," said Ansley Depp, first vice president of KDA. "We may have a bit of a redistribution problem with areas in the state. Bringing in a whole other group of practitioners is not going to solve that distribution problem. You are still going to have the same issues with people not wanting to go to certain areas of the state."

Depp added, "The best thing, we think, would be to increase the reimbursement for Medicaid so that then you have more dentists involved and willing to do the treatment."

Depp, who is slated to become the KDA president in August, added that tax credits for dentists willing to work in under-served areas and student loan-reimbursement programs would go a long way to get dentists to under-served areas.

Both those ideas were also recommended by the workgroups. They also joined KDA in supporting a tax on sugary drinks, to be used toward prevention and improving oral health-care access.

"Another thing that was mentioned here today was the possibility of a soda tax, and that is something our board has been discussing and talking about maybe promoting and finding a champion or sponsor for," KDA Executive Director Richard Whitehouse said.

The workgroups also called for more education to improve dental health literacy for all Kentuckians, especially medical-care providers, who may recognize the connection between the mouth and overall health but don't make a habit of asking their patients about their oral health.

Laura Hancock Jones, a general dentist and chair of the Kentucky Oral Health Coalition, stressed that an overarching message from the meeting should be, "Oral health is essential to overall health."

The workgroups will meet through the summer. The final strategic plan is to be revealed in October.