October 18, 2017
By Kristina Reed

Florida is failing when it comes to dental care for disadvantaged children.

According to a 2010 study by the Pew Research Center, Florida was the worst performer of the 50 states with regard to ensuring that low-income children have access to care. Florida met only two of the eight policy benchmarks, receiving an “F” grade for two consecutive years.

One major concern is that there are 32 counties in our state that have no pediatric dentists who accept Medicaid. So, it’s not surprising that only 1 in 3 Medicaid-enrolled kids receive any services.

This is tragic, and a major contributor to the rampant oral health disparities seen in low-income communities.

Why did we receive an “F” grade?

1. Fewer than 25% of high-risk schools had sealant programs. Sealants are thin coatings applied to the molars, where most cavities occur. The Community Preventative Services Task Force strongly recommends school-based sealant programs, which they determined to be both effective and cost-saving.
2. Hygienists could not place sealants without a dentist’s prior exam. The Florida Board of Dentistry voted to permit dental hygienists to apply sealants without supervision in Health Access settings, but as of July 2010, when the survey was conducted, the rule had not been put into effect.
3. Less than 26% of Medicaid-enrolled children received dental care. The national benchmark was 38.1%.
4. Only 27.5% of dentists’ median retail fees were reimbursed by Medicaid. This is a huge reason why many dentists refuse to accept Medicaid, and consequently, children don’t receive services. Even when providers do accept Medicaid, it can be difficult to get an appointment.
5. Florida hadn’t authorized a new type of primary care dental provider. Many communities simply don’t have enough dentists to meet their residents’ needs, so states are exploring new types of providers. Dental therapists in Alaska have been found to provide safe, competent care with high patient satisfaction. Some states have introduced legislation to enact an Advanced Dental Hygiene Practitioner—a master’s level degree allowing hygienists to provide restorative care.
6. Florida didn’t track data on children’s dental health. States should submit basic screening data to the national database that tracks oral health conditions. Collecting data is a key element of an effective state dental health program. Without it, states struggle to allocate resources and compete for grant funding. Tracking the number of children with untreated tooth decay and the number who have been treated is essential for policy solutions and measuring progress.

So why aren’t dentists accepting Medicaid?

• Low reimbursement: The American Dental Association (ADA) maintains that Medicaid rates do not “provide a valid reflection of market-based dental fees”. In Florida, researchers found that if fees were increased and the administrative burden lightened, the percentage of Florida dentists willing to participate would increase to 70%.
• Burdensome administrative requirements
• Excessive paperwork
• High cancellation rates and a lack of case management to assist patients in keeping appointments
• Poor oral health literacy among affected communities.
• Perceived social stigma of being a Medicaid participant
• Lack of specialists who are Medicaid participants to whom patients can be referred. To address the care for Medicaid-eligible children (especially special needs children), specialists such as orthodontists or oral surgeons may be needed.
• Poor patient compliance to treatment regimens

While it may not be possible to have the perfect dental care system where everyone has complete access to care, we can and must do better.

Being ranked as last in the United States with an “F” grade is unacceptable and embarrassing. Stakeholders, community members, organizations and activists need to prioritize oral health, especially children’s access to care when creating and discussing public policy.