Most Wisconsin Dentists Don’t Take Medicaid » Urban Milwaukee

Randall Brown stands near his apartment on Wednesday, April 17, 2024, in La Crosse, Wisconsin.

Randall Brown stands near his apartment on Wednesday, April 17, 2024, in La Crosse, Wisconsin.

2019, Randall Brown Finally got dental insurance. But for months, he couldn't find a dentist willing to see him.

At the time, Brown had great dental needs. He recently moved to La Crosse and was homeless for a while. He had also previously struggled with substance abuse, specifically the use of methamphetamine. This medication can eat away at the enamel on your teeth, eventually causing tooth loss.

“I started to really experience some serious discrimination and a little bit of cruelty from my health care providers,” Brown said.

Some dentists turned Brown away because they did not participate in BadgerCare, the state's Medicaid-funded insurance plan. He said that at the office where he handled his insurance, staff would often start the conversation by giving him a list of services he received. No qualifications, making him feel like he was being judged for having public insurance.

His options were further limited by the COVID-19 pandemic, when many dentists stopped seeing patients and waited months to reopen.

The vast majority of dentists in Wisconsin do not accept BadgerCare patients. In a 2018 survey by the state Department of Health Services (DHS), only 29% of licensed dentists said they provide services to patients with public insurance.

After years of lobbying by dental groups, Wisconsin's last state budget increased BadgerCare's reimbursement rate for dental care by 40 percent. But most health leaders agree that the number of dentists serving these patients has not increased significantly, especially as more providers in the state reach retirement age.

Today, Brown, a doctoral student in Viterbo University's Ethical Leadership Program, has help keeping his smile.

He believes people take the ability to see a dentist for granted and don't realize the many impacts that come from a lack of access. In fact, in 2020, when most people wore masks in public to protect against COVID-19, Brown said he noticed a difference in the way people treated him. They couldn't see his damaged teeth.

Dentists say low reimbursement means they lose money when seeing public insurance patients

The barriers Brown experienced are part of the reason why many BadgerCare recipients don't get dental treatment, even though their insurance covers it.

An analysis of state data by the Wisconsin Primary Health Care Association (WPHCA) found that by 2022, less than 40% of children and young adults with Medicaid coverage will visit a dentist. Even lower—only 23% of people ages 21 to 64 have received dental services, and only 18% of seniors have received dental services.

Image courtesy of WPHCA

Image courtesy of WPHCA

The same report showed that of the 878 dentists enrolled in the state's Medicaid program, nearly one in five did not see any Medicaid patients in 2022.

Dental care industry leaders say many providers are refusing to accept patients with public insurance because of historically low state reimbursement rates.

Chris HansenThe president of the Wisconsin Dental Association said that just a few years ago, dentists were reimbursed at about 30 percent or less of the typical cost of services.

The state's 2021-2023 biennial budget increases Medicaid reimbursement rates for dental services by 40%. But Hansen, who retired last year after running his own practice in Two Rivers for a decade, said current rates still leave many dentists paying less than half their normal fees.

“In many cases, they are forced to take a loss to see these patients, and many practitioners do that,” he said. “But we don’t have the ability to do a lot of cost shifting in a small practice setting like we do in a large hospital or a large medical facility with multiple providers.”

Hansen said the dental industry does see the reimbursement increase as a good start, along with new investments in student loan reimbursement programs dedicated to dentists practicing in rural areas.

A spokesman for the Department of Homeland Security declined an interview request for this article. But the agency studied the impact of higher reimbursement rates through a four-county pilot program launched in 2016.

Overall levels of dental service use among Medicaid members in the pilot counties remained much lower than among commercially insured patients. The agency's report said the pilot confirmed previous findings that “increased Medicaid payments appear necessary but are certainly not sufficient to improve access to dental services.”

Image courtesy of WPHCA

Image courtesy of WPHCA

Overall shortage of dentists means many patients face long waiting times

To further increase access, the state must also address the overall provider shortage, Hansen said.

The number of dentists retiring has increased in recent years, both in Wisconsin and across the country. The number of dental hygienists has also declined, causing some dental offices to have to reduce the number of patients they can see. Both professions have seen an increase in retirements during the COVID-19 pandemic, when dental offices temporarily closed and then had to change operations to limit the spread of the virus, Hansen said.

According to federal data, 32 of the state's 72 counties are considered areas with a shortage of dental health care professionals for low-income people. The WPHCA estimates the state needs an additional 275 full-time dentists to eliminate these shortage areas across the state.

In January, Gov. Tony Evers Signed a series of bills aimed at improving the dental nursing workforce. The state invested new money in training programs for dental hygienists and assistants and authorized the licensure of dental therapists, a new mid-level provider similar to physician assistants.

The shortage of medical providers also affects the state's community health centers — facilities that primarily treat underserved populations.

At Scenic Bluffs Community Health Center in southwestern Wisconsin, patients come from a five-county area to seek care, often driving an hour to the clinic in Cashton.

Dental Operations Director Amy Sanover The health center said it receives 800 calls a month seeking first-time appointments. She said they have eight full-time dentists and can only see about 120 new patients each month.

“If you contact us regularly every month and keep your messages updated, it would now take us about four to six months to get you on board,” she said.

But Sanover said the wait is normal for private dentists in rural areas of the state. In Monroe County, where the clinic is located, one dentist has an estimated 1,500 patients. The ratio is even higher in other rural counties, such as Waushara County, where there are nearly 28,000 patients for one dentist.

Most of Scenic Cliff's patients have Medicaid coverage or are uninsured, Sanover said. But she said they also see people who have private insurance but can't find a dentist in their area that accepts their plan.

“They are a typical rural population,” she said. “We have small business owners; we have farmers; we have families. Our patients range from young children who start seeing the dentist around two or three years old to elderly patients.

Delays in dental care can have real consequences for patients' health

Sanover said patients at community health centers often have more pressing dental needs than just regular cleanings. In many cases, their patients have deferred care due to long drives to clinics, competing financial needs, or because they simply are not used to receiving preventive care.

“I think most families have a family history of dental use that has evolved over generations,” she said. “If your experience as a kid was that you didn't go often, maybe as an adult you pick up on that.”

For Brown, barriers to care can also impact a patient's willingness to continue looking for a health care provider.

“A lot of people who are disenfranchised or marginalized, they've learned nothing,” he said. “They may not even try to seek services or ask for help because they've been turned away in the past. That's certainly something I've experienced, just being told no over and over again. There can be some frustration and anger about that.

Brown said he faced delays due to the COVID-19 pandemic and finding providers who participated in Medicaid compromised his dental health. He eventually received care at Scenic Cliff and had several tooth extractions and replacement teeth fitted.

His smile still needs some adjustments, but Brown said the change has made a big difference in his quality of life. Toothache can make it difficult to eat, speak and “look your best,” he said.

He would like to see the state take more steps to increase access to dental care, including recruiting more dentists to accept Medicaid patients. He also said that the country should find ways to expand the scope of services covered by public insurance.

During the process of replacing his teeth, Brown discovered that some of the care was considered cosmetic and was not covered by his insurance. But he says being confident in his smile is more than just vanity.

“(People) just want to be able to navigate society and not be looked down upon,” he said.

Listen to WPR report

Most Wisconsin dentists do not accept Medicaid. This leaves patients in need of care with limited options. Originally published by Wisconsin Public Radio.

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