Dentists Struggling To Serve Poor
By WILLIAM HATHAWAY
Courant Staff Writer
March 9 2005

Poor children come to his Newington dental office from as far away as
Willimantic and Putnam, but Dr. Michael Goodman says he now only treats
those in the most pain.

" If there is a small hole in a tooth and a big hole, you fix the big hole,"
Goodman said. "But you know those small holes will be big ones in a year."

As they have for more than a decade, the few dozen Connecticut dentists like
Goodman who are willing to see children with Medicaid coverage hope state
lawmakers increase their reimbursements. The dental fees - which haven't
been increased for children since 1993 and for adults since 1989 - now cover
only about 60 percent of the providers' cost to do most procedures, they
say. And if they see no increase, more children who need dental care will
find even fewer dentists who will help them.

" I'm cutting back," Goodman said. "I can't afford to stay in business."

On Tuesday, Goodman was in Hartford to help the Connecticut Oral Health
Initiative launch a new website that offers advice on dental care and gives
providers updates on legislative initiatives that affect their practices.

" We know it won't help increase access to dentists, but it is a step in the
right direction," said Robert Slate, executive director of the nonprofit
group.

Slate hopes the website at www.ctoralhealth.org will increase awareness of
what he calls a crisis in dental health care for the poor that affects more
than 300,000 Connecticut Medicaid recipients, 200,000 of them children.
Fewer than 100 of 2,500 dentists in Connecticut see substantial numbers of
patients on Medicaid, the Oral Health Initiative estimates. Goodman said
fewer than 10 pediatric dentists in Connecticut see poor children, which
means delayed treatment, days lost in school, and more teeth lost later in
life.

" Dentistry has failed children," he said.

In Hartford, the crisis is not as severe as in other areas of the state
because school-based clinics offer some dental services to poor children,
Slate said. But in many other urban and rural areas, Medicaid recipients
simply go without care.

Most "safety net" dental clinics that provide care for the poor have waiting
lists of a year or more, he said. The bottom line is about two out of three
children on Medicaid in Connecticut do not get needed care, Slate estimated.
" Somehow dental care is perceived to be less important than other types of
health care, but dental problems have been linked to low birth rates and
heart disease and diabetes," Slate said.

Dental health advocates hope to persuade more dentists to accept poor
patients by getting the state to increase dental reimbursement rates to
dentists to about 75 percent of fees normally charged. The joint
state-federal Medicaid program pays about 30 percent to 35 percent of fees
normally charged by Connecticut dentists, Slate said.

However, the state faces a budget deficit of at least $1 billion and
spending cap limits.

" I think we might be able to find ways to do this," said Sen. Toni Harp,
D-New Haven, co-chairwoman of the appropriations committee, who supports
increasing reimbursement rates.

If the legislature can't find a way to raise rates, the courts might.

Legal aid advocates have sued the state for failing to provide dental
services for the poor. A request for a summary judgment has been in federal
court in Hartford since 2003, said Jamey Bell, an attorney for Greater
Hartford Legal Aid Inc.

Bell said a ruling in favor of Medicaid recipients would allow the state to
circumvent spending cap limits.

" Dental providers are paid a fraction of what their costs are," Bell said.

Gov. M. Jodi Rell has proposed other initiatives, including $2 million to
pay for dental equipment at community health centers in urban areas. The
state would like to attract more dentists to provide services at such
centers, where because of peculiarities in Medicaid law they can be
reimbursed at higher rates, said David Dearborn, spokesman for the
Department of Social Services.

Copyright 2005, Hartford Courant