Dentists Often Turn Away Medicaid Kids Seeking Urgent Care, Study Finds

Undercover researchers have extracted some painful news about dentists they apparently often turn away children who rely on Medicaid for insurance.

In the study, a team led by University of Pennsylvania researchers posed as the mothers of a 10-year-old boy with a fractured front tooth in Cook County, Illinois, which includes Chicago.

The researchers made two calls, four weeks apart, to 85 dental practices seeking an urgent appointment. The only variation in the calls was the boy’s insurance coverage it was either Illinois’ combined Medicaid and Children’s Health Insurance Program, also known as CHIP, or private Blue Cross insurance.

The results of the study: only 36.5 percent of the supposed Medicaid beneficiaries got an appointment, versus 95.4 percent of Blue Cross–insured children with the same oral injury.

Even among the dental practices officially enrolled in the Medicaid program, only 68 children of the time were Medicaid-insured children offered an appointment.

Study co-author Dr. Karin Rhodes told HealthDay News that the Medicaid payment rate was the key factor. In Illinois, reimburses dentists for 53 percent of their median usual fees, putting the state among those below the national average reimbursement level of 60.5 percent. Although Medicaid reimburses all emergency dental care, the payments drop off for follow-up visits, which Rhodes says probably makes dentists “shy away” from taking on the patients.

Dr. Raymond F. Gist, president of the American Dental Association, told ABC News that the new study underscored his organization’s belief that “lack of funding is among the greatest barriers to better oral health in America.”

When the researchers couldn’t get Medicaid-covered kids into Medicaid dentists, nine of the dental practices agreed to schedule appointments for cash payments ranging from $30 to $205. That happened even though dentists enrolled in Illinois’ Medicaid program are prohibited from collecting cash from Medicaid/CHIP patients.

The study was published in the journal Pediatrics.




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5 comments to “Dentists Often Turn Away Medicaid Kids Seeking Urgent Care, Study Finds”

  1. Dr. Gustav Kozina

    I am an Illinois dentist and have been in practice since 1969.

    I think that there is a common misconception that Medicaid (Public Aid, All Kids, etc.) in Illinois “does not pay enough to cover the cost of running a dentist’s office” as stated by Kafba63. In many cases this is true; however there are some procedures where Medicaid reimbursement levels approach those of traditional insurance carriers.

    We may be in the minority here, but we are proud to be a respected provider of dental care, oral surgery and orthodontic treatment with braces to Public Aid, Medicaid and All Kids patients throughout northern Illinois. And unlike most of the other dentists and orthodontics in our surrounding communities, we do not limit the number of Public Aid, Medicaid or All Kids patients that we see. We do our best to accept every patient with State of Illinois dental coverage and provide them with the quality dental care they require and deserve.

    As dental health practitioners, have a duty to treat and if the sole reason that you practice dentistry is to reap the financial rewards, then maybe we should all revisit our ethics.

  2. Sonny Saggar

    Physicians should remember why they went into medicine, instead of going into Wall Street. Once upon a time, they genuinely and equally cared for all humanity. Then life and a big house got in the way. Then peer pressure to make more money. People should let the market decide who will survive. The urgent cares that accept Medicaid should be viewed by those with private plans as more caring and compassionate, and hence selected as the right destination. Beware the facilities that turn away Medicaid where payments and profits are really first, and not patients, as they will so often claim. At Eureka Urgent Care, we are proud to accept all insurances, including Medicaid and Medicare.

  3. Kafba63

    Really? This is news?
    My wife has been in dentistry for many years and this is common knowledge in the field. The reason dentists don’t like to take medicaid patients is simple – medicaid does not pay enough to cover the cost of running a dentist’s office…. The only way for a dentist to stay afloat and still accept medicaid is to become what my wife (only half jokingly) calls a “sweat-shop” – a dentist’s office that sees too many patients in a day…. Too many for the dentist or the hygienist to really spend any time and do things properly.

    When you let the government pay for things quality always (always) goes down….

  4. JGNY

    NYS just lowered the fees paid to dentist who treat Medicaid patients by 35%. This started on May 15, 2011. By May 18, a large number of dentist notified the NYS DOH that they were dropping out of the Medicaid program. The current rates paid to dentist who participate in Medicaid have not increased in over 10 years. No increases and now they cut the rates by 35 %. Why should any dentist or professional participate in these programs? The patients on these plans are the most difficult to treat as they are on medicaid because they present with a lot of medical issues. The Medicaid patient takes up more of the doctors time and cause the most problems. they are also the first patient to seek out a lawyer in the event of an possible malpractice related issue. With all of the factors and more, clearly the dentist will not give these patient priority appointments. They will only use these patients to cover down time when needed and give the private patient or insurance patient the first available time slot. Yet, this article attempts to blame the dentist. yes you did brush up against the money issue but failed to mention anything else.

  5. Arcee

    Wow. Our politicians are so smart. When will they learn. You try to circumvent the free market and you get slapped down by human nature.

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