‘Putting money where the mouth is’
Evers proposes $43 million for dental care plan
Waukesha County Community Dental Clinics provides care to low-income children, pregnant women and adults who have dental emergencies.
Accepting all adults for regular dental care isn’t a possibility.
Its clinics in Waukesha and Menomonee Falls would be overwhelmed, said Renee Ramirez, executive director of Waukesha County Community Dental Clinics.
Progressive Community Health Centers does see adults. But it schedules appointments for new patients on the 20th of each month for the next month.
The community health center would be booking appointments six to eight months out otherwise, said Jenni Sevenich, its chief executive officer.
Each weekday, the clinic, which employs three dentists and one hygienist at its clinic at 3522 W Lisbon Ave., gets seven to 10 calls from people asking for dental appointments.
Those are just two examples of one of the state’s longstanding health problems: the limited access to dental care for children and adults covered by Bad-
“Our solutions have to take care of all the people. Not just some of them.” Greg Nycz Director of Family Health Center of Marshfield
gerCare Plus and other Medicaid programs and for adults with low incomes who don’t have dental insurance.
Gov. Tony Evers has proposed spending $43.4 million over two years on an array of initiatives to help lessen that problem.
“The governor is putting money where the mouth is,” Ramirez said.
The $43.4 million included in the governor’s proposed two-year budget would be a roughly 20 percent increase a year in what the state now spends on dental care for children and adults.
The state spent an estimated $120 million in the 2018 fiscal year on dental care for people covered by Medicaid programs and for other oral health programs.
It works out to about 1 percent of the $11.7 billion in state spending on health programs in that fiscal year.
Not all of the $43.4 million in proposed spending is an increase in what the state spends on dental care and oral health, because some of the money will replace federal grants that are ending.
The money would come from a mix of state and federal funds, with $21.3 million from the state and $22.1 million from the federal government over the two years.
The governor’s proposal is the first significant increase in state spending on dental care and oral health in more than 15 years.
“We are thrilled that there is this much attention being paid to lessening some of the oral health disparities we see in this state,” said Lisa Olson, director of policy and programs for the Wisconsin Primary Health Care Association, which represents the state’s community health centers.
The limited money that the state allocates for dental care can be seen in what BadgerCare Plus and other Medicaid programs pay dentists.
According to the Wisconsin Dental Association, the programs pay:
❚ $34.61 for children and $42.41 for adults for a basic exam and cleaning.
❚ $34.58 for children and $32.57 for adults to fill a cavity.
The reimbursement rates don’t cover dentists’ costs. As a result, most dentists don’t accept or see few patients covered by Medicaid programs.
“Dentists are not looking to make money off of Medicaid — they are looking to come close to break even,” said Matt Rossetto, director of government services for the Wisconsin Dental Association.
Wisconsin now ranks 43rd in access to dental care for children based on government figures.
Roughly four out of every 10 children covered by BadgerCare Plus received dental care in 2017.
“I don’t like living in one of the worst states in the nation for getting access to dental care for children from poor families,” said Greg Nycz, director of Family Health Center of Marshfield, a community health center affiliated with Marshfield Clinic.
The figures for adults are almost certainly lower given that many do not have dental coverage and that some low-income dental clinics accept only children or give them priority.
One result is that Wisconsin hospitals saw 37,446 patients — an average of 720 a week — in their emergency departments for preventable dental conditions, such as abscesses, in 2017.
The problem has gotten worse in recent years. In 2013, Wisconsin hospital emergency departments saw 27,741 patients who were in pain because of dental problems.
Family Health Center of Marshfield, which has 10 dental clinics in north-central and northern Wisconsin, tries to keep people out of hospital emergency departments — where Nycz noted they are likely to be prescribed opioids — by keeping slots open at its clinics for emergent care.
Last year, its 10 clinics treated 6,000 people who needed care for a dental emergency.
Patients from every county in Wisconsin, Nycz said, have traveled to its clinics to get dental care. The governor’s proposed initiatives include:
❚ Increasing reimbursement rates 50 percent for nonprofit clinics if half of their patients are covered by Medicaid programs and a 30 percent increase for dentists in private practice if at least 5 percent of their patients are covered by Medicaid programs.
❚ Expanding the state’s successful Seal-A-Smile program that provides dental sealants — plastic coatings applied to the chewing surface of molars to prevent tooth decay — and preventive care in schools.
❚ Providing $1.3 million additional grants over two years to dental clinics that provide care to low-income patients.
❚ Allowing dental therapists, who would have the training to drill and fill cavities and who would work under the supervision of a dentist, to practice in the state and providing $1.5 million to a Wisconsin college that is willing to set up a training program.
“That’s what we are most excited about — they really are taking a multiprong approach,” said Matt Crespin, associate director of the Children’s Health Alliance of Wisconsin.
The Wisconsin Dental Association opposes allowing dental therapists to practice in Wisconsin and has not taken a position on Evers’ other proposals.
The association does back expanding a pilot program in four counties that more than doubled reimbursement rates for children covered by BadgerCare Plus and Medicaid.
The program showed encouraging results in Brown County, where dentists saw 4,000 more children covered by Medicaid programs in the first year.
But the results were mixed in Racine County, where dentists saw 650 more children covered by BadgerCare Plus.
It works out to roughly one out of every 26 children in the county covered by the program.
An evaluation of the program is expected soon. Advocates oppose expanding the pilot program and contend the governor’s proposal to increase reimbursement rates for nonprofit clinics that now see patients with limited access to care would be more effective.
The pilot program also does not help people in low-wage jobs who don’t have dental insurance, Nycz said.
“Our solutions have to take care of all the people,” he said. “Not just some of them.”
Community health centers, such as Family Health Center of Marshfield and Progressive Community Health Centers, receive federal funding and would not be eligible for the higher reimbursement rates under Evers’ proposal.
But the 50 percent increase in reimbursement rates would benefit nonprofit clinics such as St. Elizabeth Ann Seton Dental Clinic, an affiliate of Ascension Wisconsin; St. Ann Center for Intergenerational Care; as well as the dental clinics run by Children’s Hospital of Wisconsin.
“That would be huge,” said Ramirez, of Waukesha County Community Dental Clinics.
The nonprofit organization was founded in 2007 because of the limited access that children who are covered by BadgerCare Plus, the state’s largest Medicaid program, have to dental care. It opened a second clinic in Menomonee Falls last year with the help of a $1.65 million grant from Froedtert Health.
Waukesha County Community Dental Clinics expects to see 5,000 patients this year.
Other states also struggle with providing access to dental care: Roughly half of children covered by Medicaid programs nationally receive dental care in a given year.
Wisconsin has long ranked among the lowest in the country for access. But the state has made progress in the past decade.
The Seal-A-Smile program has been steadily expanded and reduced cavities in children. The community health centers have worked to expand their dental programs and now provide care to about 160,000 people a year. Health systems also helped fund nonprofit dental clinics and initiatives such as Ascension Wisconsin’s mobile dental clinic that provides care at schools in the Milwaukee area.
The state also now allows dental hygienists to work under the supervision of physicians, which will increase access to preventive care at community health centers and other clinics that provide care primarily to people covered by Medicaid programs or who are uninsured.
“It has been sort of piecemeal,” said Crespin, of the Children’s Health Alliance.
Evers’ proposals would only lessen the problem — and only over time.
But they were quickly endorsed by advocates and others who have been working for years to draw attention to the limited access to dental care in the state.
“For those of us who are in the field who are trying to get this job done,” Nycz said, “it is very rewarding to see that we have an administration that is willing to try multiple things to address this problem.”