Ohio Health Policy Review

ODH, HPIO release dental Care data brief

Researchers at the Ohio Department of Health and the Health Policy Institute of Ohio have released a data brief, titled “Oral Health Findings from the Ohio Family Health Survey, 2008,” (pdf, 2 pages) examining dental care in Ohio, using data from the most recent Ohio Family Health Survey.

The report found that regardless of family income status, dental care was the most pressing unmet health care need for both adults and children.

Some of the findings include:

• 479,000 Ohio children (or 18.3 percent) were without dental insurance, compared to 111,000 children (4 percent) who were uninsured for medical care
• Even though low-income children (those in families earning less than 200 percent of the federal poverty level, or $41,300 for a family of four) had higher rates of dental coverage, they were less likely to have a dental visit in the past 12 months (68 percent of low-income children, compared to 81.5 percent of higher-income children)
• 3,433,000 (or 39.4 percent) of Ohio adults 18 and older reported having no dental coverage, compared to 1,232,000 (or 14.1 percent) of adults who reported being uninsured for medical care
• For adults, family income and job status are associated with a lack of dental coverage

Brief outlines strategies for improved oral health for Medicaid enrollees

A new policy brief from the National Academy for State Health Policy outlines targeted strategies that states could consider implementing to meet the care needs of Medicaid enrollees who face particular oral health challenges (Source: “Increasing Access to Dental Care in Medicaid: Targeted Programs for Four Populations,” State Health Policy News, March 17, 2009).

The strategies in “Increasing Access to Dental Care in Medicaid: Targeted Programs for
Four Populations,” (PDF, 37 pages) are aimed at improving oral health care and access to services for four groups of Medicaid enrollees: young children, pregnant women, people with developmental disabilities and people living in rural areas.

The targeted  policy steps outlined in the brief fall into four broad categories:

• Enhancing the training of dental professionals
• Broadening service delivery sites
• Enhancing state contracts
• Using existing safety net pathways

"Targeted interventions represent an achievable step that can be made in a difficult fiscal environment,” according to the brief. “The programs are limited in scope, which contains their total cost. They are also aimed toward populations that are recognized as being of specific concern to policymakers, which can make the programs easier to build legislative and executive branch consensus around. If a state can’t achieve comprehensive reform in one leap, targeted interventions can be effective incremental steps along the way.”

Maine addresses rural dentist shortage by training docs

Faced with a shortage of dentists, especially in rural areas, Maine has teamed with the American Dental Association on a program to train physicians in dentistry (Source: “Short of Dentists, Maine Adds Teeth to Doctors’ Training,” New York Times, March 3, 2009).

The program, like similar ones in other states, trains primary care doctors on basic dental procedures and ways to identify more serious problems in patients, who are then referred to a dentist.

“I see dental complaints all the time from people who come into the E.R.,” said Dr. Andrew Fletcher, who learned dentistry during his hospital residency. “It’s mostly Medicaid patients who don’t have money to see dentists.”

Study: Dental care lacking for children covered by Medicaid

A new study by the Government Accountability Office estimates that 6.5 million children covered by Medicaid have untreated tooth decay (Source: “Kids in Medicaid have more tooth decay: study,” Reuters, Sept. 23, 2008).

Of the 20 million children in the United State who covered by Medicaid, only a third had any dental care in the past year, according to the study. About half of all children on private insurance had dental care in the past year.

"Children in Medicaid remain at higher risk of dental disease compared to children with private health insurance; children in Medicaid were almost twice as likely to have untreated tooth decay," the GAO report found.

One problem, the report found is that many parents have tried and failed to find care for their children. According to the report, "We estimate that 724,000 children aged 2 through 18 in Medicaid could not obtain needed care."

OSU dental care bus gets grant to keep treating low income children

A $450,000 grant from Delta Dental Foundation will enable Ohio State to continue offering free dental care to low income children in Central Ohio (Source: “Free dental care can roll on,” Columbus Dispatch, Aug. 29, 2008).

Since 2005, Ohio State has used a specially equipped bus to visit Columbus schools and provide dental care to students whose parents can not afford to take them to the dentist. The bus has made 5,400 visits and provided about 17,000 procedures in the past three years.

"In the scheme of things, (dental care is) often not a priority when you put it against whether or not you eat or whether or not you have the lights on in the house," said Canise Bean, director of the OHIO Project, the office at Ohio State that oversees the program.

Reopened Middletown dental center one of few to treat Medicaid, uninsured patients

After financial problems caused it to close for two years, the Middletown Community Dental Center is slated to reopen Saturday after receiving a $650,000 grant (Source: “New dental center caters to uninsured, Medicaid patients,” Middletown Journal, Aug. 12, 2008).

The dental center will be one of the few in Butler County that serves patients on Medicaid or those with no insurance at all. In fact, a survey taken last year found that just four of 96 dental offices in the county provide services to Medicaid patients.

"It's extremely important,'' said Spokeswoman Ashley K. Wladysh of the office reopening. "Dental care is the No. 1 unmet health need in Ohio...We are the only safety net in Butler County.''

Insurance plans expanding dental coverage

Increasingly insurance plans are beginning to expand dental coverage in an attempt to reduce overall health care costs (Source: “Smile -- Benefits Improve,” Wall Street Journal, July 27, 2008).

Some plans, such as Delta Dental of California, New York and Pennsylvania and Affiliates, are no longer counting diagnostic and preventive care toward the annual maximum. Guardian Life Insurance plans allow patients to roll over a share of their unused limit if they file at least one paid claim a year.

In light of recent studies linking gum disease to conditions ranging from pre-term births to diabetes to heart disease, the insurers say the goal is to encourage patients to get regular, routine care as a means to avoid more costly care down the road.

Low income Ohioans struggling to find dental care

There are an estimated 4 million Ohioans who do not have dental insurance, many of whom go to an emergency room when they have a dental emergency such as an abscess or bleeding gums (Source: “Dental clinics try to fill care gap as poor turn to ERs,” Columbus Dispatch, June 15, 2008). However, emergency rooms typically are not equipped to handle non-trauma related dental procedures.

There are 120 dental clinics that provide the kind of preventive dental care to low-income patients in Ohio that could make trips to the emergency room avoidable, but the demand far exceeds the availability of services. Further exacerbating the problem is that only about 25 percent of dentists accept Medicaid patients because they say they only get reimbursed for about half of their costs. Next month the legislator and Gov. Strickland are expected to address the issue by reinstating funding for the adult Medicaid dental program.

ADA concerned about lead in dental crowns and prostheses

"The American Dental Association (ADA) has begun a "larger-scale investigation into the safety of both foreign and domestically produced dental crowns and other dental prostheses." (Source: "Lead might be lurking in dental work," Columbus Dispatch, Feb. 28, 2008.) The ADA became concerned after WBNS Channel 10 in Columbus worked with a local dentist to order "eight supposedly identical dental crowns from four labs in China, the source of a growing number of dental implants used by U.S. dentists. The labs are regular advertisers in industry publications distributed in the United States. A certified testing facility in Cleveland found that the porcelain veneer of one of the crowns contained lead -- 210 parts per million."

As a result of the investigation, the ADA warned its members about the lead found in the crown and contacted federal authorities, including the Food and Drug Administration and the Centers for Disease Control and Prevention. The ADA also began its own investigation. Dr. Marcel Casavant, chief of pharmacology and toxicology at Nationwide Children's Hospital and medical director of the Central Ohio Poison Center, said the lead-tainted crown signals a potential health threat. "I guess that tells me I need to be a little bit more concerned about other potential sources of lead," Casavant said, "and I never would have guessed somebody would have put lead into a piece or a part installed into a human being.

Ohio kids on Medicaid have trouble finding dentists

The Toledo Blade published an article on Sunday detailing the shortage of dentists in northwest Ohio who will accept children who are on Medicaid. (Source: "A gap that needs to be filled: Dentists for Medicaid kids" Toledo Blade, Jan. 20, 2008.) "Low reimbursement rates are chief among the reasons why dentists don't routinely accept disabled or poor children covered by Medicaid. Programs in Ohio, for example, pay about 51 cents on the dollar." According to Dr. Paul Casamassimo, a past president of the American Academy of Pediatric Dentistry, "A lot of dentists can't afford to take Medicaid. It costs them money to take care of the kids." This lack of care results in dentists who do treat Medicaid recipients seeing "emergency cases where children have infections from abscessed teeth because they don't get routine dental care. In rare cases, such infections--as with a 12-year-old Maryland boy last year who had no dental insurance at all--are fatal."

Despite this, statistics show that the move to Medicaid managed-care programs in recent years in Ohio has helped increase the percentage of children seeing dentists. "Ohio, for example, has had a 20% hike in the number of Medicaid-covered children getting help over the last five years, with about half of those aged 4 to 21 having a dental visit in the fiscal year ending June 30, 2006, according to the Ohio Department of Job and Family Services."