Poor Families Aching for Dental Care

Charles Parents Find Few Openings as Providers Grow Reluctant to Accept Medicaid

James A. Heffner, a dentist in Southern Maryland, works on Walter Thomas, 4, while Walter's mother, Shenna Foster, holds his hand. Walter can get dental care through an early childhood program, which pays higher reimbursements, but Heffner no longer accepts Medicaid patients. (By Linda Davidson -- The Washington Post)

When Shenna Foster called the 800 number to find a dentist for her teenage son, Maryland's health care program for the poor offered three options: Greenbelt, New Carrollton and Fort Washington. Foster lives in Waldorf, 15 miles from the nearest location.

She does not drive, and public transportation is spotty for the journey. Six months later, her son's teeth remain a problem, with on-again, off-again pain.

There is only one general dental practice within Charles County that routinely accepts patients covered by the state, and that office won't accept new patients until summer.

"I called and asked for the dentist closest to me, and I'm still trying to find one," said Foster, a mother of four. "I've been calling for over a year."

Foster's struggle to find a local dentist is a dramatic example of the statewide and national shortage of dentists who treat patients covered by government-run Medicaid. The 8,000 children who qualify in Charles have the lowest rate of access to dental care in Maryland, according to the state Department of Health and Mental Hygiene.

The shortage is particularly trying in this emerging Washington suburb, because of the relatively small pool of private dentists -- 63 for 137,000 people -- and the limited public transportation to reach offices beyond the county's borders.

The two community clinics in Charles each have one dentist available one day a week for both adults and children.

"It's especially brutal here," said Cheryl DeAtley, the coordinator of an early childhood program that pays for dental care for about 75 of the county's youngest children from low-income families. "If they are on medical assistance, chances are they don't have the transportation, either. It's a domino effect."

The state's standards for care call for one dentist for every 2,000 people. Providers also are supposed to be located within 30 minutes or 30 miles of a patient's home.

Faye Grillo, the county's deputy health officer, said access is a problem, but "it's not an acute crisis." The county has a nurse who helps families find dentists and can arrange for transportation. Last year, Grillo said, the county hosted a dinner with the managed-care companies to try to recruit more dentists.

Maryland has bumped up reimbursements for treatment and offered other incentives to entice more dentists to serve low-income patients. Twenty-six percent of eligible Medicaid recipients statewide received some treatment in fiscal 2003, according to a federal report on participation rates. That was better than in Virginia and the District, where the rates were 22 percent and 19 percent, respectively.

"We've done a lot in recent years to improve access to dental care, and we've seen big improvements in the percentage of children getting services," said Susan Tucker, executive director of the state Office of Health Services.