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In Vt., poor go without regular dental care

Dr. Kathy Silloway examined a patient in her St. Johnsbury, Vt., office last week. Dr. Kathy Silloway examined a patient in her St. Johnsbury, Vt., office last week. (TOBY TALBOT/ASSOCIATED PRESS)

ST. JOHNSBURY, Vt. -- Dr. Kathy Silloway sees poor patients from all over Vermont at her dental practice. It's the ones she doesn't see that she wonders about. In a small state with a big Medicaid population and low reimbursement rates for dentists, many low-income people go without regular care for lack of a provider.

Half the children on Medicaid in Vermont -- and three-quarters of the adults -- don't see a dentist regularly, according to authorities. And the problem is getting new attention, thanks to an initiative by Governor Jim Douglas and the continuing efforts of US Senator Bernie Sanders, an independent from Vermont.

Finding a dentist who will treat Medicaid patients is a major obstacle. About 80 percent of the state's 352 dentists serve Medicaid beneficiaries, but far fewer treat a large number.

Dentists are deterred by reimbursement rates that range from 40 to 60 percent of their fees.

"If you're a private practitioner, it is very difficult to practice at 50 percent or less than customary fees," said Silloway, one of the largest Medicaid providers in the state. "Many practitioners find they have to limit how many they can take. You can't pay your hygienist at 50 percent less, your light bill at 50 percent less."

Add a high Medicaid population to the mix and it exacerbates the problem, making it hard to recruit new dentists who start their careers strapped with hundreds of thousands of dollars in dental school debt.

To attract new dentists and encourage more practices to take on Medicaid patients, Douglas has proposed boosting the reimbursement rate to match that given to Medicaid providers in New Hampshire. Douglas also wants to set up a loan forgiveness program for new dentists who set up their chairs in Vermont, provide young Medicaid beneficiaries with a primary care dentist, and reimburse physicians for oral health risk assessments for children.

Access to dental care is just part of the problem.

For poor adults, whose dental benefit is capped at $495 and doesn't cover dentures, seeing a dentist on a regular basis may not be at the top of the list.

"It becomes more common for these people to get an extraction and call it a day," Silloway said. "Unfortunately, we can't provide the most comprehensive service that we'd like to provide."

To encourage preventive care and meet the need, Sanders wants to add five federally qualified health clinics in southern Vermont. So far he's helped fund clinics in Hardwick, Island Pond, Richford, Rutland, and Wells River that provide, or will provide, dental care and school-based clinics in Bennington and Burlington.

The clinics, which receive higher reimbursement rates, are a sore spot for some private providers like Silloway. But her practice, started by her father in 1961, has never turned away a patient on a state program.

"We know what our calling is, and we're going to continue to do it," she said.