Florida’s public health dental program, scarce as hen’s teeth

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Florida lawmakers have a lot to congratulate each other about as the state rises in national rank on numerous economic, employment, and health care factors. 

But access to oral health care is not one of those things.

To the contrary, Florida has continued its barely abated tank in all measures of oral health: fewer low-income kids in Florida see a dentist than in any other state. Florida has the 8th worst dentist shortage in the nation, and more than one-third of dentists in Florida are above the age of 55.

This matters.

To put it bluntly, what happens in the mouth doesn’t stay in the mouth.

Oral health — and the lack of it — is linked to a growing number of systemic health problems, namely coronary artery disease, low birth weight and premature birth, and diabetes, along with a number of other unlikely sequelae such as Alzheimer’s disease and osteoporosis.

Bacteria in the mouth, when allowed to travel through the vascular system due to gum disease, releases proteins which causes inflammation throughout the body — a major culprit with far-reaching effects.  In the case of heart disease, this means plaques are more likely to clog arteries. In the case of pregnancy, women with periodontal disease are about 3.5 times more likely to give birth to a preterm or low birth weight infant.

Then there are the developmental impacts of dental disease on children: demonstrably more emergency room visits, pain, absences from school, and suffering grades.

That’s a costly spiral.  And a wholly preventable one.

Florida’s public dental health system suffers from a number of problems: organizational and leadership gaps at the Department of Health which oversees County Health Departments and is responsible for recruiting public health dentists, low Medicaid participation among dentists, and the most obvious: glaringly low reimbursement rates for the dentists who do opt to treat underserved kids.

You know how hard it is to get in with a dentist on a Friday afternoon?  That Friday afternoon is every day of the week, all year long, for low-income Floridians.

In 2011, less than one-quarter of Medicaid-enrolled children in Florida received dental care, and in 2010, only 15% of dentist accepted Medicaid patients. 

Compare this to New York, which ranks as the 10th worst state for access to dental care: there, “just” 57% of Medicaid-enrolled kids went without dental care in 2011.  That’s not great, but it is a lot better than Florida’s 85%.

And while Florida has seen some notable strides through the statewide prepaid dental program, which has measurably improved Medicaid dental networks, this effort is already in danger and improvements will go by the wayside when the program sunsets in October 2014.

Florida’s starting point is no recipe for success, but nor is it an honest excuse.

Other states have faced the same obstacles in providing oral health care for low-income children, and have seen far greater success in closing the gap.

What have these states done differently? 

For one, states such as Virginia, Maryland and Texas have made firm, long-term commitments to elevating oral health within their state Medicaid programs by separating dental care from medical managed care plans.

By contracting directly with dental managed care programs, these states have ensured that each dollar dedicated to oral health care is used for just that.

Otherwise, dental services become just one more expendable chip under an insurer’s unified medical loss ratio, to be distributed into whatever corners of care the insurer feels fit.  Where, in this type of system, does an insurer see the incentive to draw in more claims under dental? It doesn’t.

I have the feeling it won’t require the creation of a new task force or a couple dozen meetings of stating the obvious to move the ball forward.

Karen Cyphers, PhD, is a public policy researcher, political consultant, and mother to three daughters. She can be reached at [email protected]