Poor Families Aching for Dental Care

But reimbursements are still low for many procedures in Maryland, and the level of frustration because of paperwork is high, according to those in the field. Medicaid patients are also more apt to miss appointments, causing lost revenue.

Harold Goodman, a professor at the University of Maryland's dental school in Baltimore, oversees a program that sends pediatric dentists to low-income areas in the state. Even with the improvements in Medicaid, he said, the history of hassles makes dentists reluctant to get involved.

"Dental offices are quite busy and doing well with privately paid patients," he said, "and dealing with the state program has been a nightmare."

The state's Medicaid program covers 409,000 children in families earning up to 300 percent of the poverty level, or $58,050 for a household of four.

In five years, payments to dentists have doubled and tripled for routine visits and treatments. The amount for periodic checkups increased from $5 to $15, and payment for filling a cavity on one surface increased from $37 to $70.

Diane C. Herr, one of the directors who oversees the state's managed-care program, said, "We're hoping that some of the dentists who stopped taking Medicaid might reconsider, because a lot of things have changed."

But problems persist.

For years, James A. Heffner was one of the few dentists who accepted Medicaid patients in Southern Maryland. He quit when he realized he couldn't pay his bills if he continued accepting the lower payments.

The new payments are still "not enough to make a dent," he said. For instance, Heffner charges $45 for a routine checkup and $100 to fill a cavity.

Instead of jumping back into Medicaid, Heffner's pediatric practice works with an early childhood program that pays higher reimbursements and provides transportation to ensure that children make their appointments. Foster's 4-year-old son is part of that program.

Once the children reach age 5, however, they end up back in the Medicaid system -- and less likely to receive care. When children, such as Foster's 13-year-old son, put off treatment, it puts them at risk for infections, dentists say.

Heidi Read, a day-care provider in Waldorf, signed up her children for medical assistance when her husband died in 2000. The closest dentist she found was 35 miles away, in Bowie. She has taken unpaid days off work and pulled her son out of school for his appointments.

"It's a huge inconvenience for me as a day-care provider and single mother," Read said. "I just gave up because I was frustrated."

Read would like to take her 16-year-old back for dental crowns during his school vacation this month. But most offices she has called will be closed for the holiday.

The state's list of dentists who accept medical assistance is constantly in flux. The most current list of general dentists for Charles includes four people. One has closed his Waldorf office and practices in Mitchellville. Two others, who share a practice, are not accepting new patients until summer. The fourth sees patients only on Tuesdays at a community clinic in the western part of the county.

Calvin Wilson, a Waldorf dentist, recently started volunteering once a week at the Health Partners clinic to treat uninsured patients. He was reluctant to allow his name to appear in the newspaper because, he said, "I think I'm the only one in this area now."

"Once the word is out and everyone knows you do see the Medicaid patients, you become overwhelmed," he said, "and then you say, 'No, I can't take it anymore.' That's how difficult it is for a patient to see a provider."