Smile, Rhode Island – you just received an A for dental health care for low-income children.
In a study released last month by The Pew Center on the States, the Ocean State garnered top honors for providing access to dental care for children with limited family incomes. The state was one of just six to receive an A grade.
“When we finished looking at how states did, we were not surprised Rhode Island was one of the best states,” said Shelly Gehshan, director of the Pew Children’s Dental Campaign. “Rhode Island has always been creative and they have had leadership … who totally understand the oral-health program.”
Not every state does. Thirty-three states and Washington, D.C., received a grade of C or below. Nationwide, the report, “The Cost of Delay,” said 17 million low-income children fail to receive dental care each year. That translated into one in five American children.
The report ranked states in eight policy areas. They include: If it provided sealant programs for low-income students at high-risk schools; if hygienists could place sealants without a prior exam from a dentist; the share of the state’s residents receiving fluoridated public water; the share of Medicaid-enrolled children receiving dental care; the state’s Medicaid reimbursement rate; if the state pays medical providers for early preventative dental care; if it authorized new primary dental care providers in 2009 and if the state tracked data on children’s dental health in 2009.
Rhode Island met or exceeded the national average in six of the eight benchmarks. Missing the mark was the state’s Medicaid reimbursement rates. The state pays 31.7 percent of dentists’ median retail fees, compared with the national average of 60.5 percent. The state also did not authorize any new primary care dental providers last year.
But overall, the state fared well. Pew said 50 percent to 74 percent of high-risk schools had sealant programs last year, 84.6 percent of residents received fluoridated water in 2006 and 43.8 percent of Medicaid-enrolled children received dental care in 2007.
The Medicaid Program pays $12.73 per member, per month, or about $7 million annually. Burnett said the state considers that “a very good value” that pays dividends in the future by improving overall health and lowering the state’s future medical care costs.
Rhode Island launched the program after receiving permission from the federal government to use its Medicaid dollars in a different way than traditionally prescribed, a step that appears to have led to improvement in oral health care for low-income children, Gehshan said.
“It’s just a really innovative and smart approach,” she said.
Factoring in children of all family incomes, the Pew Center said 28.2 percent of third-graders in Rhode Island had untreated tooth decay, placing it in the middle of the pack of states surveyed. Meanwhile, the percentage of Rhode Island children enrolled in Medicaid and receiving dental care has risen for six straight years. In 2001, the percentage of children enrolled in Medicaid and receiving dental care stood at 36.3 percent, by 2004 that number increased to 37.7 percent and by 2007, the most recent data available, it was 43.8 percent. The national average was 38.1 percent.
Dr. Francis Connor, president of the Rhode Island Dental Association, said it helped that about 217 dentists, nearly half the state’s dentists, participate in the Medicaid program. That allows dentists to start educating parents early about dental health and prevents problems down the road.
But while Connor called Rhode Island a national model, he said the state’s relatively low reimbursement rate discouraged more dentists from participating in Medicaid. It was an issue that Gehshan said the Pew Center recognized as well. But Gehshan said that simply paying more does not always solve the problem.
That’s why Pew is urging states to explore creating a new level of dental providers that can provide routine primary dental care, something akin to the nurse practitioner in general medicine. That could increase opportunities for access to dental care and alleviate pressure on dentists. Within the next year or so, Gehshan said the Pew Center plans to release a report detailing the impacts that a new mid-level practitioner would have on private dental clinics and on the economy.
And the Pew Center says that increasing access to dental care is as much about health as it is the economy. The study said the consequences of poor dental care for children are severe. Citing a 2000 study by the U.S. surgeon general, the report says more than 51 million hours of school are missed each year because of dental problems. Presumably along with them in many cases were parents clocking out of work to take their children to the dentist.
And untreated oral problems often fester and require more expensive procedures to correct, the cost of which may trickle back to taxpayers supporting programs such as RIte Smiles.
“Unlike so many of America’s other health care problems, the challenge of ensuring disadvantaged children’s dental health and access to care is one that can be overcome,” the report said. “There are a variety of solutions, they can be achieved at relatively little cost, and the return on investment for children and taxpayers will be significant.” •
