01/04/2008
Medicaid restoration delay affects dentists and patients across Ohio

Sarah Surface
Managing Editor

The recent decision by Governor Ted Strickland to indefinitely delay the restoration of adult dental Medicaid benefits and provider fee increases from Ohio's state budget affects dentists and patients across the state.

Gov. Strickland's plan, announced in March 2007, was to restore all the services eliminated during the previous administration and reverse the fee reductions. However, the restoration plan has been delayed due to budget concerns and escalating Medicaid caseloads.

The effects of the Medicaid changes implemented by former Governor Bob Taft have been felt since Jan. 1, 2006, but many dentists were anticipating the restoration of the benefits originally scheduled to take effect Jan. 1, 2008.

Dentists have felt the crunch of reduced fees in their practices, as expenses have gone up, but Medicaid reimbursement fees have gone down.

ODA member Dr. Tom Niederhelman, of Newark, has seven offices throughout the state that regularly see Medicaid patients. He is now faced with the difficult decision of potentially laying off staff members and reducing office hours because of the lack of funds provided through Medicaid fees.

"For the past two years, I have lost money in each of my offices by continuing to see Medicaid patients and work with the private insurance companies associated with them," said Niederhelman. "I have been struggling to retain staff during this time and thought if I could hold out until January, the state would return to the 2000 fee schedule and I would be able to get out of the red."

Unfortunately for Dr. Niederhelman, and other dentists across the state, he will have to hold out for the fee increases indefinitely.

Chris Moore, ODA director of dental services, said other Ohio dentists are facing similar problems.

Many dentists have been offering services to Medicaid patients knowing they would lose money but anticipating an increase in fees on Jan. 1. These philanthropic services are a way for dentists to give back to their communities, but they are not the answer to affording access to care under the Medicaid program.

"Charity alone is not a dental plan," said Moore. "Charity cannot be relied upon to meet the needs of Ohio's citizens who are covered by the Medicaid program."

Some dental office staffs had also begun implementing the new Medicaid fee schedule into their billing systems. Their anticipatory work will now need to be undone due to the restoration delay.

The postponement of adult dental Medicaid benefits will also have a negative impact on the oral health of vulnerable populations, especially those who would have been covered by the restoration.

Because of the anticipation of full restoration of dental coverage on Jan. 1, many Medicaid patients delayed following through with their treatment until the beginning of the year. Now, with Strickland's announcement, many patients may forego treatment altogether.

"Not seeking treatment for oral health problems in a dentist's office will most likely lead to a visit to an emergency room, which is much more expensive and does not provide definitive treatment," said Dr. David Heisel, dental director for the Columbus Public Health Department and the Columbus Neighborhood Health Centers and member of the ODA Medicaid Working Group. "Worst cases can end up with admittance to a hospital."

Heisel said the restoration delay will also impact Safety Net dental clinics across the state. Safety Net dental clinics provide a significant level of oral health care to the underserved and are likely to see an increase in the number of patients who are unable to pay for their care.

Dr. Henry Fields, ODA president and former dean and current section head of orthodontics at The Ohio State University College of Dentistry, said the cutback in reimbursement fees limits what the college's dental clinic can do for its patients.

"The dental college will lose a significant source of funding for its clinic," said Fields. "Students will be denied training opportunities for treating underserved populations in a culturally competent manner."

Dr. Stan Vermilyea, associate dean for clinical affairs at the OSU College of Dentistry, said the student clinics at the college saw a 64 percent reduction in the charges billable to Medicaid in 2006 when compared to charges in 2005.

The numbers of patients and patient visits have also dropped significantly since the enacted cuts. In 2006, Medicaid patients comprised 14 percent of all patients and 9 percent of all patient visits, compared to 25 percent and 20 percent, respectively, in years prior.

Vermilyea anticipates a continued decline in Medicaid services and income at the student clinics because of the recent decision to indefinitely delay dental Medicaid benefits.

Watch for more information concerning the dental Medicaid program in future issues of ODA Today and find updates on the ODA Web site.