A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

The State's Dental Health Crisis

The State's Dental Health Crisis

April 5, 2005

Chip Joffe Halpern runs the Ecu-Care program in North Adams that helps uninsured persons get medical care. He's also President of HCFA's Board of Directors. He writes a twice-monthly column for the North Adams Transcript. His column last week was a great summary of our oral health disgrace in Massachusetts.

"Thursday, March 31, 2005 - This past year, the Massachusetts Society for the Prevention of Cruelty to Children released a disturbing report revealing that dental decay is now the most widespread chronic childhood disease -- five times more common than asthma and seven times more common than hay fever. The prevalence of dental disease falls disproportionately on children covered by MassHealth, the state's health insurance program that covers one out of every four children in Massachusetts.

The seriousness of this critical problem cannot be overstated. Consider these findings from a survey of third graders in Massachusetts: 65 percent of children on MassHealth had a history of dental disease, 40 percent had untreated decay and 16 percent of these children had urgent needs requiring immediate care.

The MSPCC report emphasizes how critical this problem is for all children: "The implications of untreated dental illnesses are serious and can be permanent. Significant tooth decay, pain, or infection can inhibit learning, speech, and eating, leading to problems in school, negative self-image, and poor nutrition. More than 51 million hours nationwide are lost each year due to dental-related illnesses."

A U.S. Department of Health and Human Service study adds: "Oral infections and disease in childhood have been linked to increased risk for future decay, and chronic oral infections are associated with an array of other health problems later in life such as heart disease, diabetes, and unfavorable pregnancy outcomes."

The reasons for the children's oral health crisis in Massachusetts have been well documented by a statewide Oral Health Advocacy Task Force of dental and healthcare leaders, and academicians. The Task Force notes that while over 450,000 children are eligible for MassHealth dental benefits, fewer than 15 percent of Massachusetts' dentists accept MassHealth members. The result is that an appalling 70 percent of enrolled children do not have access to care.

Dentists from North Berkshire tell me that they see children whose parents drive over two hours for an appointment, because no MassHealth dentist in their area is available to treat them.

Dentists give a number of reasons for not participating in the MassHealth program. This includes cumbersome administrative procedures and inadequate reimbursement rates that have been far lower than private rates. In addition, because of current regulations, they cannot limit the number of MassHealth patients they see, thus putting them at risk of becoming overwhelmed with new MassHealth patients seeking services.

Recently, important first steps have been taken to address this urgent problem:

* Gov. Romney has proposed allowing dentists to cap the number of MassHealth patients that they would have to accept. But, now the Legislature must also agree to approve this.
* The state recently increased reimbursement rates for dentists participating in MassHealth. But the rate is still lower than the median rates of the private market and there is real concern that these rates will not attract a meaningful number of new dentists into the program.
* Based on a review of upcoming reports, the Legislature must decide whether or not to allocate the funds necessary to put into place a third-party administrator to run the MassHealth dental program. This would remedy the current administrative struggles that dentists experience. Implementing a third-party administrator is considered crucial if we are to be successful in recruiting more dentists into the program.

Addressing the children's dental crisis will require a long-term commitment involving expanding access to preventative care and treatment, oral health education, nutrition, and expanding fluoridation initiatives. But the next 12 months will be critical in determining whether or not we will be making real progress toward addressing this long overlooked children's health struggle.

A state legislative staff member once shared with me that, as a child, her family relied on MassHealth as their source of insurance. Fortunate enough to have access to a dentist, she shuddered to think what may have happened if she wasn't able to receive this necessary care during her childhood.

A fourth of all children in Massachusetts will now depend on the Legislature to strengthen the MassHealth dental program, so they too can have access to basic dental care.

Charles Joffe-Halpern is the executive director of Ecu-Heath Care and the president of the Board of Directors of Health Care for All in Boston. He can be contacted at cjoffehalpern@nbhealth.org.