Studies show that poor oral health can make young people suffer in ways adults would never tolerate. "For some kids, they are scared forever. I know people who will not talk. They will not open their mouth. They will cover their mouth," said Dr. Tryfon Beazoglou, who recently co-authored a report with Joanna Douglass, also from the University of Connecticut's School of Dental Medicine. "Often many of these children have had pain for so long that they act out in other ways and it's picked up as behavioral problems in the class room," Douglass said.
That's not all. Decay in baby teeth can lead to permanent tooth loss. Dental disease has also been linked to organ failure, cardiovascular, and other diseases. But that's not the fate of many poor children in Connecticut. After a 2008 settlement, which forced the state to restructure its dental insurance plan for Medicaid, low-income children on Medicaid are accessing dental care at rates higher than other states.
The report found that children in the state's top ten cities are seeing the dentist as often as their peers with private insurance. Overall, about 300,000 young people in low-income families are getting dental care through the Husky A program. In Hartford and New Britain, that's 75 percent of kids on welfare, which was far from the case before 2008.
The Medicaid law required the program to provide dental services for children. But it took 32 years and a lawsuit by the Greater Hartford Legal Assistance Program to show the state was not in compliance. Nine years later, the state settled under several conditions. "One was that there was a significant increase in provider rates for children's services," said Mary Alice Lee, a senior policy fellow with Connecticut Voices for Children.
Before the settlement, reimbursement rates for dentists hadn't been adjusted since 1993. In some instances the rates increased by 100 percent. For a cleaning, the amount the dentist get went from $24 to $65. And the system itself was consolidated from four companies down to one provider. "So, as a dentist providing services, you didn't just deal with one company. You dealt with four. And each one had separate billing services, had separate phone numbers, so it was very complicated," said Joanna Douglass.
The new provider pushed private dentists to participate in a system, which no longer gave insurers incentives not to pay out claims. Lee says it also sent members reminders to see the dentists.
Elizabeth Krause is vice president of policy for the Connecticut Health Foundation, which commissioned the report and sponsors WNPR's Health Equity Project. "We saw the number of participating providers increase in almost all towns in the state," she said.
It took a lot for that to happen. Historically, private dentists hadn't treated many Medicaid patients. Dr. Beazoglou says dentists argued welfare patients often faced transportation issues were more likely to miss appointments. Some even said regular patients wouldn't want to see them.
So, the state threatened to create new clinics. The Connecticut State Dental Association got involved. And according to Joanna Douglass many dentists changed their tune. "Many times people have said that private dentists will not get involved with public insurance. And I think we're finding out that In Connecticut, that is not the case. When you do pay dentists close to market rates, they will see and treat patients on Medicaid, which is wonderful news," Douglass said.
Even with these gains, Connecticut again is behind with dental fees rising by about four percent every year. "Eventually as the economy picks up and rates are not adjusted, it's a big question of whether the dentists will continue providing care to the less affluent kids," Beazoglou said.
It could be tough to maintain oral health access rates for children in times of budget constraint. It's not cheap. The state's Office of Policy and Management says dental costs for Husky A members was $142.3 million last fiscal year. Governor Dannel Malloy has proposed to adjust the eligibility rates for parents on Medicaid. CT Health estimates some 11,000 members would likely not receive oral health benefits if they were uninsured or purchased private health insurance next year as part of the Affordable Care Act.