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Decaying dental care

ON PAPER, dental care for children covered by Medicaid should be no problem. Unlike most of their parents, they are eligible for reimbursement for the checkups and cavity repairs that should spare them the pain and related health problems of decayed teeth. But in Massachusetts, the ugly truth is that just 12 percent of dentists are willing to treat Medicaid children, with the result that 70 percent of the state's poor children don't see a dentist.


In a state that holds itself up as a world leader in medicine, this is a shameful case of institutional neglect. Other states do better, according to Marylou Sudders, head of the Massachusetts Society for the Prevention of Cruelty to Children. In collaboration with 28 health organizations and 10 state legislators, the MSPCC has just published a highly critical report on children's unmet dental needs. Sadly, many of its points echo ones made in 2000 by a special legislative commission.

Since then, dentists' participation in Medicaid has declined even though there have been two increases in reimbursement rates for Medicaid dentists. Those rates, which in many cases are still below dentists' standard fees, are just one reason dentists boycott Medicaid. They find the paperwork burdensome and object to the law that requires them, if they accept any Medicaid patients at all, not to limit the total number they treat. This makes them concerned they will be overwhelmed by Medicaid patients who, dentists also complain, often miss appointments.

The report's short-term recommendations are that reimbursement rates be increased to a level that ensures enough providers; that the state find a third-party administrator to run Medicaid's dental program in a more efficient way; and that the state proceed with a pilot project in Worcester that has gotten a statutory exemption to allow dentists to limit the number of Medicaid patients in their practice. That pilot would also make use of a third-party administrator.

For the long term, the state has to help school districts develop more dental clinics in elementary schools in the areas of greatest need. More state funding for dental sealant and fluoride rinse programs would also reduce tooth decay among children. Because of state budget cuts, funding for fluoride rinse programs actually dropped this year from the year before. Just 62 percent of the state's people live in communities where the drinking water is fluoridated, even though it reduces tooth decay by 40 percent. Pediatricians should be encouraged to do basic screenings of children and refer them to dentists when needed.

The tooth decay of low-income children is a correctible problem that states much less wealthy than Massachusetts have managed to handle. The state cannot claim to be providing basic health care for children if they are not getting dental care.

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