Oregon is in the bottom third of the nation for access to dental care for low-income children, according to a new study, and Jackson County stands out as a dentist-shortage area.
The report from the Pew Charitable Trust says a major problem in providing dental care is that so many dentists won't honor Medicaid — government-paid medical coverage for low-income people — because of its low reimbursements and complex paperwork.
Jackson County is no exception.
"In the Rogue Valley, it's broken. It's a concerning situation, though it's not hopeless," says interim La Clinica dental director Amy Fine. "We have a large population whose dental needs are not being met, and we've barely scratched the surface."
La Clinica (spelling corrected) is among the health care options locally for low-income people, operating numerous medical clinics in Jackson County and in recent years expanding its dental care. Community Health Center also provides dental services, including an outreach program to rural schools.
La Clinica also visits local schools, with a mobile team treating children with sealants, educating them about dental care and screening them for treatment.
But those programs address only a small portion of the need, clinic managers say.
It's hard to get low-income families enrolled in Medicaid, hard for them to find a dentist who honors Medicaid, hard to get them to go to the dentist and hard for them to pay for it, no matter what the cost, says Fine.
"The greatest problem is the blue-collar uninsured, including illegal immigrants," says Fine. "The question is: 'Can they get to a dentist?' So we have the mobile health care clinic. Then, 'Do they have the ability to pay?' So we have a sliding scale, to make it as low as 50 percent on a limited basis."
The Pew study says 54.5 percent of Oregon kids on Medicaid didn't see a dentist in 2011, making the state 35th in the nation in providing access.
It says 17.3 percent of Oregonians live in a dental-shortage area. That shortage is most prominent in rural areas or places with high numbers of low-income people. That takes in Eastern Oregon and Southern Oregon, including Jackson County, says Fine.
Another red flag, says the report, is that 37.1 percent of Oregon dentists are older than 55 and likely will retire soon, thus adding to the shortage.
Looking at the statistics, Fine said, "There can be tons of dentists, but if they're charging an astronomical rate, they (low-income people) are not going to go."
The reality of Medicaid for dental work, says Cynthia McCarty, dental program manager for Community Health Center, is that "Medicaid doesn't pay very well."
"It doesn't even cover their costs," she said of the dentists. "Their offices are being inundated by Medicaid patients. They can't keep up. They couldn't keep their doors open if they took them all."
The only possible way to provide dental care for everyone, says McCarty, would be to require every licensed dentist to have 6 to 8 percent of cases be Oregon Health Plan (Medicaid), thus "spreading it evenly over the whole profession. No one would go broke. In small communities, it might have to be 10 to 15 percent."
As it is, dentists who see Medicaid patients tend to do just one filling at a time, spreading them over many months to cut their losses, says McCarty. But that forces parents in remote areas to skip a day's work to drive to town and back.
"It's horrendous for families," McCarty notes. "They can lose a month's worth of groceries, plus the cost of gas."
To alleviate the situation, which is a "big burden on families" in the Upper Rogue, CHC is creating a dental clinic in Butte Falls. Health center staff has visited schools, doing fluoridation, screening and much-needed dental education, and they also help arrange transportation.
"Often, kids don't know who their dentist is," she says. "And often they say they don't have a toothbrush. We give them the whole kit: toothbrush, toothpaste, floss and a timer so they brush for two minutes."
Because Southern Oregon is largely rural and has a large number of low-income people, "We have a huge population of underserved," McCarty says.
There are 130 dentists working in Jackson County, says Julie Wurth, La Clinica spokeswoman. That's one for every 1,592 people. That compares to a slightly better ratio for the state — one for every 1,494.
There are 77,000 low-income people with no or low dental insurance in Jackson County. This is the target population for La Clinica, says Wurth. About half of La Clinica dental patients pay on a sliding scale, she adds, with Medicaid accounting for 42 percent of the clinic's patients.
"If you call and have pain or abscess, you get seen within 24 hours," says Fine, adding that the development of the dental programs has reduced such visits to area emergency rooms.
In its dental prevention program, in Eagle Point, White City, Butte Falls and Prospect, CHC has seen almost two-thirds of the 3,174 students in those areas' schools and referred 620 for care last school year and 522 this year, for a reduction of 16 percent.
The reduction, says McCarty, is because CHC works with families to get kids on Medicaid or refers them to the Children's Dental Clinic in Medford. A total of 285 were uninsured last school year and only 176 this year.
In 2014, millions of children will get dental coverage under the Affordable Care Act, further increasing problems of access, says the Pew report. It encourages states to increase reimbursement and streamline paperwork in their Medicaid programs — and to increase training for dentists. This state trains dentists at Oregon Health Sciences University.
John Darling is a freelance writer living in Ashland. Email him at firstname.lastname@example.org.