Going to the dentist can be expensive. And under the Affordable Care Act, Vermonters have increased access to insurance for dental services, including Medicaid. But many dentists do not accept new Medicaid patients.
That’s because many private practitioners say reimbursement rates are too low. When Jim Gold practiced dentistry in Thetford, he did not accept Medicaid. But now in retirement, he volunteers at the Good Neighbor Health Clinic in White River Junction, where low income patients can get free oral health care at the Red Logan Dental Clinic.
“We’re seeing patients in crisis,” Gold says. “They’re in pain, the situation is acute, they’ve neglected their teeth for a long period of time, they haven’t had access to care and they haven’t placed a high value on their health.”
The clinic has one staff dentist paid by the state of Vermont to treat Medicaid-eligible patients. Care for uninsured or underinsured people is provided by supervised dental interns from Harvard and Boston University. Five hundred patients received free dental care at the Red Logan Clinic last year. But manager Karen Holbach says she has to turn away a lot of people in pain because of staffing shortages. She says many patients cannot find a dentist who will accept Medicaid, so they call the clinic.
“The amount of new patient phone calls coming in now is just unbelievable, like it’s never been before, because they gave a lot of Vermonters dental but they didn’t increase the number of providers,” Holbach says.
The state’s roster of Medicaid-enrolled dentists may be misleading, because while over 80 percent of Vermont dentists accept Medicaid, many of them are not adding new patients who need it. There are eight federally-qualified health clinics that do accept Medicaid and treat uninsured patients, but parts of the state are still underserved.
Robin Miller, director of Vermont’s Office of Oral Health, says it's hard to recruit new dentists to rural areas. But she says some dental assistants are getting additional training to perform some tasks like filling teeth after the dentist drills them.
“So you can increase the number of patients you can see in an office by employing this person,” says Miller.
Vermont’s Department of Health also supports a proposal to license a whole new class of dental providers called “therapists.” Trained at Vermont Technical College, they would provide basic care at a lower cost than professionals with more advanced training. Proponents say therapists could serve some of the Medicaid population, not just in dentists’ offices but in schools and nursing homes.
The Vermont State Dental Society strongly opposes licensing therapists. Executive Director Vaughn Collins explains why:
"What we don't want to have happen is to have two tiers of health care in the state of Vermont such that Medicaid recipients only get seen by a dental therapist who is nowhere near as well-trained as a dentist," Collins says. "So that would be really unfortunate and something we wouldn't want to participate in."
But retired dentist and Red Logan Clinic volunteer Jim Gold says therapists would be held to the same standards as dental school graduates for the narrow range of services therapists would be allowed to perform.
“Basically the opposition is fear-based,” Gold says. “It is not grounded in any facts. It is not grounded in statistics from any states that have had dental therapists, nor from other countries."
Minnesota allows dental therapists to be licensed, and so does Australia.
The Vermont Senate has voted in favor of the dental therapist measure. It still needs approval in the House.