Editorial: Improve access to dental care for pregnant women, diabetics

By The Herald Editorial Board

Few people will tell you that they enjoy going to the dentist, but no one likes the idea that they couldn’t get the help of a dentist when they needed it.

Many have dental coverage through their employer, but about a quarter of Washington residents rely on Medicaid to provide health care. Since 2014, adult dental care is again covered as part of Medicaid, also known as Apple Health, but the coverage often goes unused because patients in need of regular cleanings, fillings, tooth extractions and other dental work can’t find a dentist willing to accept Medicaid patients because reimbursement rates are so low and the system delays care for patients.

Only about 23 percent of adults with Medicaid coverage have access to dental care.

“Despite critical expansion of services covered by adult dental Medicaid, Washington’s reimbursement rates are so low that often they don’t even cover the overhead costs for a dentist to see a patient,” said Edmonds dentist Dr. Brittany Dean in a guest commentary in The Herald in November.

The current Medicaid reimbursement rate for dental care in the state is 28.7 percent of commercial dental insurance charges, among the lowest in the nation.

Snohomish dentist Dr. Eve Rutherford agrees. Rutherford, during an interview last week with The Herald Editorial Board, said that current Medicaid reimbursements don’t cover her office’s costs to provide the services of a dental hygienist for a basic cleaning, much less that of a filling or dentures.

Rutherford sees about 30 Medicaid patients, but loses money caring for each one.

Both Rutherford and Dean participate in regular mass dental clinics. In October, the floor of Seattle’s KeyArena was filled by dentists, hygienists and others who provided free dental care for more than 3,000 low-income people. But even caring for 3,000 in one day doesn’t come close to providing the care that people need on a regular basis.

Washington and Apple Health do a good job, however, when it comes to child dental care. Since the mid-’90s, Access to Baby and Child Dentistry, a partnership among the the state Health Care Authority, the University of Washington School of Dentistry, local dental societies, community-based organizations and the Washington Dental Services Foundation, have worked to increase dental care access for children.

Better access has cut in half the number of preschoolers from low-income families with tooth decay, to 13 percent in 2010 from 26 percent in 2005. ABCD served a total of 165,000 children in 2014. And that increased access has saved the state money. Dental costs are cut nearly in half for children who receive their first preventive visit by their first birthday, compared to those who don’t see a dentist until they are four or five years old.

Washington Dental Services Foundation, which is supported by insurance provider Delta Dental, now wants to extend that success to adults, specifically focused on pregnant woman and adults with diabetes. The foundation and its supporters are seeking the state’s financial support for a pilot project that would increase Medicaid reimbursement rates specifically for those two groups of patients.

Good dental health translates to better general health for everyone, but in particular for pregnant women and diabetics.

Dental disease and infections can cause complications during pregnancy, including pre-eclampsia and gestational diabetes, Rutherford said. And mothers with untreated oral disease can pass on cavity-causing bacteria to the infant. Likewise, the inflammation and infection associated with gum disease can result in difficulties for diabetics in controlling blood sugars, leading to an increased risk for heart disease, kidney disease, blindness and amputations.

As was demonstrated with the savings from preventive care for children, the investment in care for adults, as studies of care for insured adults have shown, would result in significant medical cost savings for the state. The foundation estimates that if 18 percent of Apple Health-covered adults with diabetes received regular treatment for gum disease, it would mean $10 million in savings to the state over a two-year period.

The foundation is seeking about $1.5 million in state support for the three-year pilot program, matched by federal and other sources, to improve the Medicaid reimbursement rates, provide continuing education to dental professionals on treating pregnant woman and increase the allowed cleaning visits from once a year to four times a year for diabetic patients.

State lawmakers, who started their session Monday, face numerous and deserving requests for funding. With the potential to share in the success seen by ABCD, improving the access of pregnant woman and diabetics to good dental care offers better health for patients and the financial well-being of Apple Health.