Medicaid expansion means new oral health benefits, but will NC dentists step up for hundreds of thousands of people? | Robesonian

When North Carolina expanded Medicaid this month to give more than half a million people access to government-subsidized health care, the new beneficiaries could get a brighter smile.

The state’s Medicaid program offers comprehensive oral health benefits such as routine cleanings, exams and other preventive services. Care considered “medically necessary” includes certain oral surgeries, periodontal care, tooth restorations, denture fittings and placements — with complete replacements every 10 years and partial replacements every five years.

Some of those new smiles may turn into grimaces, however, when new Medicaid beneficiaries try to get a dental appointment: Only about 45 percent of North Carolina dentists accept Medicaid patients. Furthermore, many of those dentists are not accepting new Medicaid beneficiaries.

Oral health care providers and advocates say there are many reasons for the lack of providers accepting new patients on Medicaid rolls. A big one, they say, is that the reimbursement rate has stayed the same for 15 years.

“The North Carolina Medicaid dental provider network is in serious crisis,” wrote Frank Courts, chair of the North Carolina Dental Society Council on Oral Health and Prevention, in a letter to the editor recently published in the Neuse News and other publication. “…With the Covid pandemic and resulting inflation, the actual cost of providing dental care is higher than Medicaid reimbursement rates, which were at the same level as in 2008.”

For years, dentists have tried to remind insurers and others in the health care industry of the importance of recognizing the connection between oral and systemic health.

Poor oral health can have a negative impact on conditions such as heart disease and stroke, diabetes, pregnancy and dementia, research shows.

“The people of North Carolina deserve an oral health care system that supports their overall health,” added Courts. “It is incumbent upon state leaders to find ways to adequately fund dental care for Medicaid recipients. Accomplishing this will save state funds in the long run and result in a healthier and more productive population.”

Zachary Brian, associate professor and director of the Dentistry in Service to Community program at the UNC Adams School of Dentistry in Chapel Hill, said this week in a phone interview with NC Health News that he is “over the moon” that North Carolina is now one of 40 states with expanded Medicaid benefits.

“The policy is slow, it might take longer than we’d like,” Brian said. “At the end of the day, it should be celebrated.”

How did we get here?

Republicans who lead the state Senate and House of Representatives have resisted expansion for a decade, despite an all-out campaign by Democratic Gov. Roy Cooper.

Senate leader Phil Berger, a Republican from Eden, had a change of heart and told his chamber in 2022 that expanding Medicaid was the “right thing to do.” His move to expand also came after the Biden administration put billions of dollars in federal incentives on the table.

However, that year, the House was not fully on board, in part because of other health care policy changes attached to the proposal.

In 2023, both chambers agreed to accept the change but attached the expansion to the state’s budget approval, a document that contained policies and changes that Cooper did not support.

However, Cooper allowed the budget to become law without his signature, and enrollment of new Medicaid beneficiaries began on December 1.

Now Brian and other oral health providers are working to ensure that new Medicaid enrollees get full benefits.

Looking at the challenges

Even if all dentists who accept Medicaid patients did so, that would not be enough providers to care for the 600,000 people expected to be added to the rolls. Furthermore, there are fewer dental practices and dentists in rural areas than in more urban and suburban parts of the state.

For decades, North Carolina ranked in the bottom half of states nationwide for the number of dentists per 10,000 people.

In 2001, according to a report compiled by the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill, North Carolina had only 4.2 dentists for every 10,000 residents, placing it in 47th place. In 2013, North Carolina rose to 44th in the nation with 4.8 dentists per 10,000, and four years later the state ranked 37th in the nation. In 2022, the state will be 24th in the nation with 5.6 dentists per 10,000 people. The national average is 6.1 dentists for every 10,000 residents.

Of the state’s 100 counties, all but six are Dental Care Health Professional Shortage Areas, according to a map created by the Rural Health Information Hub with data from the federal Department of Health and Human Services.

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