Medicaid Patients Encounter Great Difficulty in Obtaining Dental Care Nationwide

Due to what the General Accounting Office calls the "unwillingness of dentists" to see Medicaid patients, and the perception that dental services for adults are "an optional component of Medicaid," the poor nationwide encounter difficulty getting dental care, the Des Moines Register reports. Many dentists refuse to accept Medicaid patients, and the wait for those dentists who will is often several months or years long. According to the General Accounting Office and the U.S. Surgeon General, dental disease is now a chronic problem for the nation's poor. Low reimbursement and cumbersome paperwork make dentists reluctant to accept new patients, according to Robert Harpster of the Iowa Dental Association. The Register reports that while Iowa Medicaid pays dentists about 70% of actual costs, the national "norm" is 47%. Many dentists also reportedly feel a Medicaid clientele "reflects badly on their practice." A 1999 survey of Missouri dentists found that one-third of respondents said Medicaid patients made other patients in the waiting room uncomfortable. Sixteen percent of Iowa dentists expressed the same concern in a similar 1996 survey.

Limited Recourse
Despite federal requirements to provide Medicaid beneficiaries with services at an availability comparable to that offered to the general population, many states fail to comply with the law because "dental services are considered an optional component" of the program. Jane Perkins, director of legal affairs for the National Health Law Program, said that class-action lawsuits are "about the only way" to force states to abide by federal accessibility requirements. According to Perkins, 16 states have been sued over equal access to dental care, with judges ruling against the states and ordering increased access to dental care in 13 of those cases. The remaining three cases are pending (Kauffman, Des Moines Register, 12/31).