For more than 13 years, CareLink Inc. has traversed Rhode Island with a mobile dentistry practice, serving elderly, low-income patients in nursing homes who rely on Medicaid plans that only offer partial reimbursements for dental care.
Some funding used to fuel the mobile dentistry clinic comes from the nonprofit’s fundraising efforts and through grants, according to CareLink CEO Christine Gadbois.
But with no updates to the compensation formula for dental services under the Rhode Island Medicaid Program since reimbursement rates were set in 1992, the roughly 25% of dental fees covered through the program is proving to be insufficient, even as the nonprofit continues to serve more clients than ever, Gadbois said.
And the impact of inflation and other new costs – including COVID-19-related expenditures – have made the financial situation even worse for Carelink’s mobile dentistry clinic, Gadbois said. It’s now becoming tough to make ends meet, while still providing adequate pay to retain its skilled team of dental professionals, she said.
“Demand is outpacing our ability to serve everyone who needs mobile dental care right now,” Gadbois said. “The issue becomes one of access for our most vulnerable citizens. It’s a problem for all adults dependent on Medicaid for their dental coverage.”
There’s now a $135.69 gap between the costs incurred for each Medicaid patient seen by the CareLink mobile clinic and the amount that’s reimbursed through Medicaid, marking the largest deficit for dental visits that the nonprofit has ever seen, Gadbois said. This comes as the CareLink mobile clinic caseload has hit a peak, with more than 14,000 visits per year serving 3,000 patients at 53 nursing homes.
Concerns over the compensation rates have been long-standing, causing most dentists in private practice to refuse or severely limit the amount of Medicaid patients they see. And the amount of private practice dentists submitting Medicaid claims has dropped in recent years, with less than 18% of dentists seeing any adults covered by the state’s Medicaid program, down from 29% of all Rhode Island-licensed dentists in 2012, according to R.I. Department of Health records.
The burden has shifted to busy nonprofit dental clinics and federally qualified health centers that are seeing a disproportionately large number of these clients, according to an October 2017 report from the state health department.
“I think it’s just come to a crisis point, where the access has just become more limited,” Gadbois said.
CareLink officials warned that a failure to meet the dental health needs of Medicaid patients could be a much bigger health problem in the future, due to the association between poor oral health and chronic diseases such as diabetes and heart disease. Preventative dental care pays for itself, warding off more costly Medicaid-covered emergency room visits, CareLink says.
“The rate that was established in 1992 doesn’t reflect the 2021 operation costs of our efficient organization,” said Dr. Jeffrey Dodge, lead dentist with CareLink’s Mobile Dentistry Program. “Investing in this program will save the state money in future health care costs.”
State Sen. Louis P. DiPalma, D-Middletown, had pledged to file legislation supporting increased funding for mobile dentistry programs. The senator said he also learned of a new proposal by the state Medicaid program that offers greater compensation and covers more dental services. DiPalma said he is going to support that plan and will still file a bill in the upcoming legislative session urging Gov. Daniel J. McKee to adopt recommended changes.
“We need to address the health and welfare of Rhode Island’s most needy folks,” DiPalma said. “If we’re not looking out for them, nobody is.”
McKee’s office and the Department of Health did not immediately respond to requests for comment.
The fiscal year 2023 budget request from the R.I. Executive Office of Health and Human Services proposes an injection of $9.2 million to enhance Medicaid-covered dental care, with roughly $3.2 million of that from the state’s general revenue and $5.9 million from federal funds.
Of that, $7.2 million is proposed to boost reimbursement rates. And $746,979 is specifically set aside in the proposal to boost the state’s mobile dental services offered by CareLink, increasing the baseline reimbursement from $102 per encounter to $180 per encounter, enabling mobile dentistry to reach 1,500 additional Rhode Islanders per year.
The funding request states that increasing the rate to compensate providers for at least 60% of the costs of providing service to Medicaid patients, rather than the roughly 25% offered now, will lead to better participation among private dental practices and alleviate problems with access to care. Department of Health data provided shows that African Americans and Latinos are three times more likely to visit a hospital emergency room for tooth-related pain or infections.
However, Martha Dellapenna, director of the Center for Quality, Policy and Financing at the Washington, D.C.-based Medicaid/Medicare-CHIP State Dental Association, said she’s skeptical about seeing significant changes in compensation. Dellapenna, a Warwick resident who previously served as Rhode Island’s dental program manager at the Office of Health and Human Services, said she’s seen failed attempts before.
The sheer amount of state funding required has been a roadblock, she said.
“The rates are so low that it’s going to take a lot [of state funding],” Dellapenna said. “Dental health is considered the bottom of the totem pole. So, there’s not a lot of time and energy spent to solve the problem.”
Marc Larocque is a PBN staff writer. Email him at Larocque@PBN.com.
