Medicaid dental coverage one big irritating toothache
Believe it or not there is a word even scarier than the phrase "drill baby drill" when talking about dental care. That word is Medicaid.
The program helps those eligible and dental offices that accept it, but many feel that Medicaid dental coverage could be improved.
"It depends on how you look at it," said Marcy Decker, eligibility supervisor for the Stark County Social Services. "Medicaid does cover a variety of dental procedures, but not all, so it's good that people are getting covered but it would be nice if it covered more."
Jodi Hulm, administrator of
Health Tracks and Healthy Steps
for the North Dakota Department of Human Services, said Medicaid covers preventive exams (two per year for children, one per year for adults), X-rays, cleanings, fillings, surgery, extractions, crowns, root canals, dentures (partial and full) and anesthesia for low income children, pregnant women, elderly and people with disabilities.
"Prior authorization is required for some dental procedures, but that process is similar to what other insurance companies have," Hulm said.
In the event that Medicaid does not cover the procedure, the patient is left paying out of pocket or going without the care they need, Decker said.
Shannon Galster, a dentist at Dickinson Dental Center agrees and added that in extreme cases going without the care can lead to emergency care or extractions.
"Sometimes it can be hard for patients to find dentists who accept Medicaid because they get reimbursed by the state and end up having to absorb some of the cost themselves," Decker said.
"When accepting new patients at our office we try not to know whether or not they are on Medicaid," Galster said. "We try to treat everyone the same, but with that being said we are limited in the amount of Medicaid we can accept because of how much we get reimbursed for the procedures."
Galster said the percentage dental offices get reimbursed depends on how much they charge, at his office they get reimbursed for about 60 percent of what they normally charge for a procedure. He added that they get reimbursed better for children than adults.
"So we definitely take a loss whenever you do a procedure that Medicaid is reimbursing you for. You either break even or take a loss, so I can understand why some dentists choose not to accept Medicaid, because it is a business and you have to pay bills."
Galster added his office chooses to accept Medicaid because as a medical professional he and many others take an oath to treat everyone.
"We are very blessed on the western side of the state," Galster said. "Most dentists in Dickinson do accept Medicaid. I think people out here have bigger hearts, are more understanding and have compassion for their fellow man."
Galster said that because dental offices take a loss it has to be made up somewhere, and often times that means raising fees.
"It's not the ideal way to handle the loss, I've heard the argument 'why doesn't the government just distribute the cost to everyone,' but I don't know if that is the answer either," Galster said. "It's a tough situation for all parties involved. I think it will be tough to find a solution that will work for everyone."
Hulm said eligibility for Medicaid is determined at the county level and is based on income and assets. Funding for Medicaid is shared by federal and state governments.
More than 60,000 people in North Dakota are receiving Medicaid, according to the Department of Human Services website.