Minnesota dentists say low state payments hurting care for poor

By Don Davis
Forum News Service
ST. PAUL - Many Minnesota dentists pay money out of their own pockets to care for poor patients because, they say,  the state pays them too little.
Sen. Julie Rosen, R-Vernon Center, and some of the state’s 4,000 dentists launched a campaign Thursday to let the public know that Minnesota pays the least of any state for children’s dental care and is fourth worst in paying for adult care through the state’s Medicaid program, known as Medical Assistance.
The state’s Medical Assistance payment is 27 cents on the dollar that dentists receive from private pay patients. At that level, dentists say that they pay for much of the care for the poor.
A simple tooth filling could cost a private pay patient $90, but Medical Assistance would pay just $27, dentists said.
Rosen told about one Martin County dentist who treated so many poor patients that “last month he made zero dollars.”
A Rosen bill, with Republican and Democratic legislative supporters, would spend an estimated $80 million to $100 million in the next two years to bring Minnesota up to the average of all states.
“Minnesota is dead last ... ” said Dr. Peter Cannon of St. Paul, president-elect of the Minnesota Dental Association. “You can’t go any lower. We are failing our children.”
Cannon said that dentists are not proposing “going from the bottom to the top,” but just asking that Minnesota payments are average.
“Last place is not what Minnesotans expect in health care,” Dr. Mary Seieroe of Hennepin County Medical Center said.
Poor, rural Minnesotans are the most affected by low payments, Rosen said, and have the most to gain by her bill.
Minnesota’s neighbors all pay more to dentists through their Medicaid programs, with North Dakota more than doubling the Minnesota payment.
Cannon said that rural dentists cannot afford to fund poor Minnesotans’ dental care.
In many cases now, rural and urban poor alike go to emergency rooms with oral pain. However, dentists say, ERs only treat pain, not the underlying cause. That can force patients back to emergency rooms when pain returns.
Dental leaders said ER visits are far more expensive than normal care by dentists. In a recent three-year period, Medical Assistance recipients cost $148 million when they went to ERs for dental problems.
Seieroe said the biggest chronic illness problem among children involves dental issues.
Her Hennepin County Medical Center alone treats 6,000 dental patients of all ages in the emergency room each year.
Complicating the situation around greater Minnesota is lack of dentists.
Two counties - Big Stone and Mahnomen in western Minnesota - have none. Murray, Swift and Marshall counties, also all in western Minnesota, have one dentist per 9,000 or more residents.
Legislators have told stories this year about communities being threatened with losing dental care because their dentists are retiring.
Other state legislation is being discussed to relieve the rural problem.
Dentists and Rosen said a proposal to forgive student loans if they agree to practice in rural areas could be a great help to increase the number of rural dentists.
The campaign launched Thursday is called Help Minnesota Smile ( www.helpmnsmile.org ) and uses the theme: “It’s hard to smile when you’re in last place.”