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June 2001 (Vol. 2, No. 8)
Dental Care Access In Wisconsin
By Rodney Moen, Senator WI State
Legislature, David West, Representative, WI State Legislature, Laura Rose,
Deputy Director, WI Legislative Council
Wisconsin currently experiences a significant
problem with access to dental care services for its residents.
Contributing to this problem is a shortage of dentists.
The Wisconsin Dental Association, a statewide trade association of
dentists, recently commissioned a study on the dental workforce shortage
that shows that, between the years 2001 and 2010, Wisconsin will experience
a net loss of 297 dentists, which represents approximately 10 percent of the
current workforce of 2,979. (Wisconsin
Dental Association Summary of Wisconsin Dental Workforce Report prepared by
Tryfon Beazoglou, Ph.D., Howard Bailit, D.M.D., Ph.D., and Dennis Heffley,
Ph.D., University of Connecticut Health Center, January 2001).
Nationally, the ratio of dentists to the
total population is also declining. According
to the Surgeon General’s Report on Oral Health in America, published in
May of 2000, there were approximately 58.4 professionally active
dentists per 100,000 people in the United States in 1996, down from 59.1 in
1990. By 2020, the dentist to
population ratio is expected to drop to 53.7 per 100,000.
In addition, the absolute number of active dentists will decline
after 2000, due to retirements of dentists, with insufficient numbers of new
dental school graduates to replace them.
Applicants to dental schools declined by 4% in 1998, with further
declines of 8 to 10% expected for 1999 and 2000.
Although
the shortage of dentists affects everyone, low-income populations, such as
those receiving Medical Assistance (MA) and BadgerCare, face a greater
problem than other populations with regard to access to dental services.
Data from the Wisconsin MA program shows that 57.6% of licensed
Wisconsin dentists were MA-certified as of June, 2000.
Of this number, 42.3% of certified dentists submitted claims to the
MA program in state fiscal year 2000. For
that same year, only 22% of Wisconsin’s MA population received any dental
services. These access rates
are significantly lower than those of the general population.
The Surgeon General’s report cites studies estimating 43% to 65% of
the United States population visiting a dentist each year.
Survey estimates vary depending on the question and survey method
used.
Dental access problems for persons of low income
are not confined to Wisconsin. The Surgeon General’s Report cited a 1996
report by the U.S. Department
of Health and Human Services Office of Inspector General that estimated that
80.3 % of infants, children and youth who are eligible for Medicaid do not
receive preventive dental services. It
is difficult for Medicaid recipients to find dentists who will take them as
patients. One reason for low
participation by dentists in the Medicaid program is the low reimbursement
rate for dental services provided by states, which averages 47% of usual and
customary fees.
The Wisconsin legislature responded to the
dental access problem by establishing the Joint Legislative Council’s
Special Committee on Dental Care Access in the summer of 2000.
The Special Committee, which consisted of 3 Senators, 5
Representatives, and 13 public members, met 7 times in the state capitol
between September 2000 and February 2001. The Committee developed two pieces of legislation, which have
been introduced into the 2001 Wisconsin legislature as 2001 Senate Bills 166
and 167, and Assembly Bills 366 and 367.
To address issues related to the supply of dental personnel, the
legislation recommends the following:
- Change licensure procedures to make it easier for
dentists from other jurisdictions to move to Wisconsin and obtain a
dental license.
- Increase the number of slots at the Marquette
University School of Dentistry for Wisconsin residents qualifying for a
tuition subsidy from 25 per class to 40 per class.
- Allow dental hygienists to practice in a variety of
settings without a dentist in the facility and without a prescription
from a dentist if the dental hygienist meets additional experience and
educational requirements.
- Allow dentists to delegate dental procedures to
dental hygienists and dental assistants, subject to certain
restrictions.
The Committee reviewed the low participation rate among
licensed Wisconsin dentists in the Medicaid program.
Concerns were raised by dentists regarding the inadequacy of Medicaid
reimbursement and the burdensome administrative requirements imposed by
Medicaid. To address administrative concerns, the DHFS established a working
group that is making progress on these issues.
In addition, the Committee recommends the following items with regard
to the Medicaid program:
·
Increase the Medicaid reimbursement rate for dentists to the 75th
percentile of the fees from the American Dental Association fee schedule for the
region that includes Wisconsin.
·
Allow dental hygienists to be reimbursed under Medicaid for services that
are covered by Medicaid and that are within the scope of practice of a dental
hygienist.
·
Provide reimbursement for two dental cleanings per year for adults.
·
Require the DHFS to report on its efforts to reduce prior authorization
requirements for dental services and to simplify the process for obtaining prior
authorization.
The Committee also made recommendations to improve
service delivery of services to patients, including preventive and educational
services. These items include:
·
Provide funds for grants to entities such as community health centers for
the provision or expansion of dental care services, with preference given to
centers in dental health professional shortage areas.
·
Provide coverage under the state’s “Healthcheck” program for fluoride
varnish treatment for children ages birth to age five.
·
Establish a grant program for community water fluoridation activities.
·
Provide funding for one public health dental professional in each of the
five DHFS regions, to provide dental care outreach activities and direct
services to the Medicaid population.
As of the date of this brief, the Senate Bills have
been reported out of the Senate Committee on Health, Utilities and Veterans and
Military Affairs, and await action
by the Assembly Health Committee. Consideration
of this legislation should result in significant discussion of the issue of
dental access in Wisconsin by policymakers this legislative session, and
increased awareness of this problem throughout the state.
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