Poor Families Aching for Dental Care
Charles Parents Find Few Openings as Providers Grow Reluctant to Accept Medicaid

By Ann E. Marimow
Washington Post Staff Writer
Tuesday, December 20, 2005

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.

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."