State dental care falls short

She's a single mom who searched more than two years before finding a dentist willing to treat her three children, whose teeth cleaning and other dental work is paid for by the state's insurance plan for the needy, called MassHealth.

He's a dentist who won't see patients covered by MassHealth but would if the state paid more and made the program less burdensome.

And both Sharleen Campbell and Dr. Richard LoGuercio are angry with the state.

Massachusetts is defending its MassHealth Medicaid program for children's dental care in federal court, where healthcare advocates have sued, arguing that the state is violating the civil rights of needy children.

The advocates, part of the group Health Care for All, say the state has refused to adopt changes that would make it easier for the half-million children enrolled in MassHealth to receive dental treatment. They say children of the poor wait months, even years, for an appointment to pull a rotting tooth or fix other dental problems.

The delays, families and dentists argue, are the consequence of a state system that pays dentists too little, requires them to complete too much paperwork, and demands that if they accept one Medicaid patient into their practice they must take every Medicaid patient who comes seeking care. While about 5,000 dentists practice statewide, fewer than 800 treat Medicaid patients, according to state figures.

So, when one of Campbell's daughters had a tooth abscess a few years ago, she called and called before finding a dentist in Quincy who would provide treatment -- a difficult trip from the family's home in Kingston because of her unreliable car. And when her son needed four baby teeth surgically removed, it meant more phone calls, more persistence -- and a trip to Bourne.

''You call them at the dentist's office and they say, 'What kind of insurance do you have?' " said Campbell, who holds down two jobs, one at the counter of a Dunkin' Donuts and the other as a monitor on a school bus. ''And when you tell them MassHealth, they say: 'Oh. No, sorry, we don't take that.'

''It's very frustrating. With children, they're growing up, they need to have their teeth taken care of. That's the only set they will have."

Mounting scientific evidence indicates that oral health may be a bellwether for life-threatening illness. Patients with advanced gum infections, for example, tend to have more plaque in the carotid arteries, the large blood vessels leading to the brain. But that link, dental specialists said, often does not translate into public policy.

''It's still difficult to get people to think of a dental problem as a health problem with consequences for overall health," said Mike Monopoli, director of dental public health policy for the parent of Delta Dental of Massachusetts. ''When there are resources that have to be divided up, it's hard to keep oral health as something that is important to policy makers."

Last year, a report chronicling the dental health of children in Massachusetts indicated stark differences between children whose care is covered by private insurers and children who rely on MassHealth to foot the bills.

Screenings performed on third-graders found that 48 percent overall had experienced cavities and other dental problems, but among families whose children rely on MassHealth, 65 percent had endured such problems. And 16 percent of the children on MassHealth had complications, such as abscesses, needing urgent treatment -- more than double the incidence in families with private insurance.

In recent weeks, Delta Dental, the largest oral health insurer in the state, has unveiled an initiative designed to improve access to treatment for the poor. Delta is giving $4 million to the Boston University School of Dental Medicine to establish scholarships for low-income and minority students. In return, students agree to practice in a needy community after graduating.

There is little dispute that a pressing problem exists in Massachusetts -- even the lawyer pleading the state's case in federal court conceded that point during closing arguments earlier this month.

Before James Arguin, an assistant attorney general, could begin making his case, US District Court Judge Rya W. Zobel asked, ''Is it the position of the Commonwealth that there's no problem?"

''We do admit there's a problem; we do admit there's room for improvement," Arguin said. But he later argued that the state was not in violation of US rules mandating that public medical programs that are federally supported must offer care comparable to that of private insurers. Zobel has not yet ruled in the case.

Arguin maintained that the poor receive emergency dental care in a timely fashion, but acknowledged that the state ''must do a better job of reducing the time new patients spend waiting for nonemergency care."

The delays are a source of concern to families -- and to dentists. Although it is not a party to the lawsuit, the Massachusetts Dental Society agrees that MassHealth is in desperate need of reform. Karen Rafeld, chief policy adviser for the dentists group, said dentists who participate in the state plan can expect to be reimbursed for services at the lowest end of the payment range.

But that is not the only reason dentists refuse to participate, Rafeld and other health policy specialists said. They are also dissuaded by the state's system for submitting claims, which is not compatible with private plans.

And a provision that is intended to give the poor equal access to dentists has had the unintentional consequence of steering dentists away from becoming MassHealth providers, advocates for the needy said.

''If a private-practice dentist takes one MassHealth child, they have to take all who want to come," said Janice B. Yost, president of the Health Foundation of Central Massachusetts, which works to improve healthcare in Worcester and surrounding communities. ''Who's going to be the first dentist to step forward and take children who are not paying his costs?"

LoGuercio used to treat children on MassHealth at his practice in Randolph but stopped years ago, when the program's administrative requirements became too onerous, he said. ''It didn't make me feel very good at all," LoGuercio said. ''I still don't feel good about it. And it wasn't just the fact of the economics."

In fact, LoGuercio said, if the state made participation in MassHealth easier and increased reimbursement somewhat, he and other dentists would be willing to participate even if fees were lower than private plans. Until then, he said, he and other dentists would rather provide urgent care free of charge to several poor patients rather than deal with MassHealth.

''I know a lot of dentists who do that," LoGuercio said. ''But you're right -- that's a dent in the ocean of care that needs to be provided."