When the state started a program called Denali KidCare last year, money began flowing for 11,000 more children to see dentists. But finding the dentists to see them has been a problem in parts of the state.
Not enough dentists accept Medicaid to handle the demand, said Brad Whistler, health program manager for the children's portion of the state Medicaid program. This was a problem even before Denali KidCare; the new program just made the problem more obvious, he said.
Denali KidCare is an expansion of the Medicaid program for children and pregnant women in families with incomes up to twice the poverty level.
``In Sitka now we don't have any dentists that are seeing new Medicaid patients,'' Whistler said. In March of this year only one dentist in Juneau was accepting new Medicaid patients, although now two are, he said.
There also are problems in Kodiak and the Kenai Peninsula, he said. Rural Alaska communities, which generally are served only by visiting dentists, have some of the worst problems with access to dental care.
In places where dentists aren't taking new Medicaid patients, children are still able to get in for treatment of problems such as cavities or abscesses, but not for routine cleaning and exams, Whistler said. In some cases the state has paid for children to go to other cities for care if it's not available locally.
Whistler said there isn't an overall shortage of dentists in Alaska. ``It is mostly a Medicaid, Denali KidCare issue,'' he said.
Medicaid is not a popular program for dentists for many reasons. Among other problems, dentists say the program doesn't reimburse them their full rate, the billing process is cumbersome, and participating in the program opens them up to audits.
``It's a multifaceted problem,'' said Martha Reinbold, executive director of the Alaska Dental Society.
Alaska's Medicaid program pays dentists more than most states, Whistler said, but it still pays less than federal or state employees' dental insurance.
For instance, Medicaid pays $114 to $151 for a routine checkup and cleaning, he said. That compares to about $170 his state worker insurance paid for his children's routine preventive care.
In addition, Medicaid patients can be frustrating for dentists to work with, Whistler said.
Dentists say lower-income patients are less likely to show up for appointments.
Doug Weaver, president of the Juneau Dental Society, said he's seen that problem in his practice. That can be frustrating for a dentist who may have put off seeing an established patient to take care of a new Medicaid patient who doesn't keep the appointment, even though reminder calls are made.
``Everybody kind of loses -- your patient and the Medicaid patient because they're not there, and your office loses,'' he said.
Whistler said the higher no-show rate among poor families may be due to a lack of reliable transportation or day care.
Also, because of the lower reimbursement rate, dental offices may schedule Medicaid patients for times that are hard to fill and may book the appointments three to four months in advance, Whistler said. The children may no longer be eligible by then, or their parents may have taken a job that doesn't allow time off to meet the appointment.
Whistler said dentists also find it frustrating that low-income patients tend not to follow through on recommendations for improved hygiene and nutrition, possibly because their parents didn't learn good dental care themselves.
Weaver said it's not that Juneau dentists don't want to help.
``Everyone in town is always willing to see immigrants, people with no money, charity work,'' he said. The combination of problems with Medicaid, however, ``can frustrate some offices where they just say to heck with it.''
His office does takes Medicaid patients, and only turns away new Medicaid patients when the practice is so busy that all new patients are being turned away, he said.
The state has been working with the Alaska Dental Society to try to come up with some solutions to the problem.
P.K. Wilson, provider and beneficiary services unit manager for the state, said the state is working on a better electronic claims submission process, and other ways to make the process smoother, she said.
After seeing some improvements, the Alaska Dental Society had planned to make a make a videotape detailing the changes and pushing for dentists to once again take more Medicaid patients.
That effort came to a halt, however, when a young dentist was accused of wrongdoing after his practice was audited. Such audits are one of the reasons dentists hesitate to be part of the program, Reinbold said, and some dentists felt the state's pursuit of that case was overly aggressive.
Whistler said the Department of Law, not Health and Social Services, handled that case and he doesn't know enough about the details to know how serious the offense was.
The state also plans to take another look at its rates, Whistler said. However, the state already pays higher Medicaid rates for dentistry than most states.
It's not clear that an increase would help improve access, Whistler said. Most practices are already fairly busy, he said, and more money might not mean they have any more time to see new Medicaid patients.