FILLING A BASIC DENTAL NEED
Clinic sees thousands of patients with limited options
The response when Lake Area Free Clinic opened a dental clinic shows the limited access to dental care for people without dental insurance or covered by BadgerCare Plus or other Medicaid programs.
The clinic also shows the work that some nonprofit organizations have done to help lessen the problem.
Lake Area Free Clinic in Oconomowoc was founded in 2001 to provide medical care to people without health insurance. It opened a dental clinic in late 2017 — and almost immediately was seeing more patients seeking dental care than medical care.
“Many of them haven’t had access to dental services in years,” said Mary Reich, executive director of Lake Area Free Clinic.
The clinic had 7,686 patient visits last year, and 4,190 of them were for dental care.
It expects to have 7,000 patient visits for dental care this year.
The response probably wasn’t a surprise. In 2017, more than 700 adults received care for emergent dental conditions, such as severe pain from an infection, at the emergency departments of ProHealth Care’s hospitals in Waukesha and Oconomowoc and at Aurora Health Care’s hospital in Summit.
Lake Area Free Clinic provides dental care only to adults. That’s because Waukesha County Community Dental Clinic, founded in 2008, focuses on providing care to children at its clinics in Waukesha and Menomonee Falls. Its clinic in Menomonee Falls opened last year with a gift from Froedtert Health.
Desperate need for care
Lake Area Free Clinic’s board decided to build the dental clinic after a survey of dentists in Waukesha County who accepted patients covered by BadgerCare Plus and other Medicaid programs found only one who was taking new patients.
“We were getting desperate calls from people,” said Megan Welsh, director of marketing and development for the clinic.
Dentists in private practice don’t accept or limit the number of patients who are covered by Medicaid programs because the reimbursement rates don’t cover the cost of providing care.
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.
Those rates are one-third to one-half — or less — of what commercial insurance will pay, with the exception of the reimbursement rate for a basic exam and cleaning for children.
Dental care accounts for about 1% of the state budget for health programs.
Gov. Tony Evers proposed a roughly 20% increase in what the state spends on dental care for children and adults — the first significant increase in spending on dental care in more than 15 years — but the proposal was rejected by the Legislature.
Lake Area Free Clinic stays away from politics. But Reich acknowledged that the clinic would have benefited from the governor’s proposal to increase reimbursement rates 50% for nonprofit clinics if half of their patients were covered by Medicaid programs.
The clinic bills the state or the managed care organizations that contract to manage the care of people covered by BadgerCare Plus. Co-pays and contributions make up the shortfall.
ProHealth Care and Aurora Health Care also support the clinic, accepting referrals for patients who need specialty care and providing lab and imaging services.
Lake Area Free Clinic’s dental clinic accounts for roughly $810,000 of its $1.3 million budget.
The clinic employs one dentist full time and two dentists part-time. It also employs one hygienist full time and one part-time.
They are supported by five dentists and four hygienists who volunteer their time. Three other volunteers help with administrative tasks.
In all, Lake Area Free Clinic has roughly 260 volunteers — physicians, nurse practitioners, physician assistants, nurses, interpreters and others.
Built by volunteers
The new dental clinic — an addition to the medical clinic — was even built by volunteers, some of them in their 70s and many of them who also worked on a new building for the medical clinic in 2009.
“The joke was they got the band together,” Welsh said.
The clinic initially provided basic dental care but soon expanded its services to include more complex procedures, such as root canals, partial dentures and crowns.
Patients are billed at cost for the additional services — $450 for a partial denture and $550 for a crown — and can make payments.
Those services can be life-changing for some people, such as a homeless woman who wanted front teeth for a son’s wedding or a man who was seeking a job but missing his front teeth.
“It was the last piece in his turning his life around,” said Reich, the executive director.
Uninsured patients are charged a flat fee, ranging from $25 to $35, based on their income for basic dental care.
The clinic has a fund for people who don’t have the money for the co-payment and doesn’t turn anyone away, Welsh said.
Lake Area Free Clinic also has established a relationship with Waukesha County Technical College. The clinic typically has three dental hygiene or dental assistant students and an instructor working at the clinic on weekdays during the school year.
It also has affiliations with the University of Wisconsin-Milwaukee, Carroll University, Alverno College, Concordia University, Medical College of Wisconsin, Marquette University, Cardinal Stritch University and others schools.
Lake Area Free Clinic was booking dental appointments three to four months out before adding a full-time dentist. That’s now down to about six weeks out, with about 250 people waiting to get dental care.
“There still remains a significant waiting list,” Reich said.
But all of those people — and more than 1,000 people before them — would have had a much harder time getting dental care were it not for the Lake Area Free Clinic.