With 49 percent of Polk kids on Medicaid, dental care an issue.
Limited number of clinics accept Medicaid's low pay rate.
By Marilyn Meyer
LAKELAND — Public health officials and those who provide health care to low-income families agree there is a large gap in need and available services for the more than 65,000 children and teens in Polk County who rely on Medicaid for dental care.
A few private-practice dental clinics in the county accept the low reimbursement that Medicaid pays to treat children. Many don't, hamstrung by meeting their own operating costs when Florida Medicaid reimbursements come in at about 37 percent of the standard rate from most insurance companies.
There are other options for persistent parents.
The Florida Department of Health in Polk operates four dental clinics that provide basic care. Last year 6,613 children ages 17 and younger, whose families were unable to find affordable dental services elsewhere, were treated at those clinics, said Nicole Riley, public information officer.
And Central Florida Health Care, a federally qualified community health clinic that specializes in primary care services for low income, uninsured and underinsured people, operates dental clinics at four locations in Polk County, said Ann Claussen, chief executive officer.
“We see the need for dental services and we do everything we can to hire the staff and expand services in Polk County,” Claussen said.
ONE PRIVATE PRACTICE
“We treat all our patients the same; we see Medicaid, no-insurance and cash-pay patients the same as insured patients,” said Dr. Jordan Tarver of Dentistry for Children in Lakeland. Although some practices may find it necessary to limit the number of Medicaid patients, “we do the best we can with whomever calls and whoever comes through the door.”
The majority of the practice's patients have private insurance or are fee-for-service patients, Tarver said. “We are not taking in as much reimbursement for the Medicaid population as from private dental plans, but Dr. (Harry) Bopp has been here for 40 years and we have a really good base of patients. We are fortunate we can see everybody.”
There definitely is a need for more providers seeing Medicaid patients, Tarver said. “We have patients that drive from all parts of county and even counties beyond because they have trouble finding a provider, some of the parents tell us,” Tarver said.
“There is no doubt a shortage of providers,” he said. Parents could get frustrated looking at a provider list (supplied by a managed care plan) because you may see the same names over and over because the dentists are working out of different offices.
“Sometimes the filing and processing of the claims for the Medicaid treatment can be more difficult than standard private dental insurance and there are more restrictions, more pre-authorizations,” Tarver said. Still, “We have good relationship with all the Medicaid dental plans and have not had any issues.”
Before the state switched to Medicaid managed care plans, dental offices dealt directly with the state and the guidelines were uniform.
“Now instead of dealing with the state, we are dealing with individual dental companies. They each have different rule books, but as long as we are aware of rules and follow guidelines, it is do-able.”
Tarver said his practice has the benefit of “a good staff that can process the claims, read the handbooks and interpret. In some offices, that could be difficult.
A Ledger survey of websites among pediatric and family dental practices found very few practices in Polk advertise they accept Medicaid (among them Dentistry for Children where Tarver practices with two other dentists). At least one dental practice says upfront that it does not accepted managed care plans (a category that includes Medicaid patients). But most list the dental plans they accept and invite prospective patients to call or sign up online to see whether their plan is accepted.
The Health Department clinics see dental patients in Lakeland, Bartow, Haines City and Auburndale. Many Florida counties do not offer dental services but Polk can because its clinics' funding is supplemented with money from the Polk County half-cent sales tax that provides health care for the uninsured poor.
Voters will be asked on the November general election ballot to extend for 25 years the half-cent sales tax for indigent health care. The current half-cent tax was approved by voters in 2004 and is due to expire in 2019.
That same sales tax also boosts services for Central Florida Health Care's dental program and for dental programs operated by other nonprofit groups.
Central Florida Health Care operates dental clinics in Winter Haven, Lake Wales, Mulberry and Frostproof. When the new Winter Haven Women's & Children's Clinics opens next month in a building at 201 Magnolia St., it will include a pediatric dental clinic. The move means there will be more capacity to see adult dental patients at the existing dental clinic on First Street North and more capacity to treat pediatric dental patients at the new facility, Claussen said.
It's still in the works, but there are long-range plans to add pediatric dental services at the pediatric primary care clinic on South Florida Avenue in Lakeland and to expand capacity for dental services in Frostproof, she said.
“In the past, we have not focused as much on pediatric dental patients as adults because we need to find pediatric dentists, which are not always easy to find,” Claussen said. “But there is such a need to treat the pediatric dental patient that we are exploring options.”
That exploration has led to conversations with a consultant out of Hillsborough County who has a program that prevents childhood tooth decay by providing dental sealants to children in all the Title 1 schools in the county, Claussen said.
We are in the initial stage of looking at it and still need to get with the school district and the School Board to see if they are OK with it,” Claussen said. "There is such a need and this is one way to provide preventive services."
- Marilyn Meyer can be reached at firstname.lastname@example.org or 863-802-7558. Follow her on Twitter @marilyn_ledger.