MADISON, Wis. — State officials are working to push through long-delayed funding to dentists who provide specialized care in Wisconsin, and lawmakers are calling for solutions in upcoming legislative sessions to address the issue of some who wait years for adequate dental care.
The news comes in the wake of a News 3 Now investigation in May, uncovering how some people with special needs in Wisconsin were on years-long waiting lists for dental care that needed crucial in-house or hospitalized sedation.
‘This is getting to be an emergency now,” Karen Scullion in Iowa County said of her adult son Trent, who has cerebral palsy and had gone three years without care as she frantically searched for a dentist able to take him. “The other day he told us his tooth on this side was hurting. I looked; his crown fell off.”
While exact data on the problem isn’t available, experts estimated it was potentially impacting hundreds in the state in cases where people need sedated care because of disabilities or health needs. A combination of factors like key dentist retirements in Dane County, as well as the closure of a hospital dentistry program in 2016, are contributing to the worsening problem, according to Dr. Patrick Tepe with the Wisconsin Dental Association.
“This is, truly, a crisis,” Dr. Patrick Tepe told News 3 Now in May. “This is not just a south-central Wisconsin problem; this is a statewide issue.”
State officials now working to apply $2.5 million to problem
A complex array of factors are driving the problem, but at the core of the issue is the lack of appropriate Medicaid reimbursement for dentists providing sedated care, which in part has led to a lack of incentive for dentists to get trained to offer this type of specialized care.
“Oral health is a critical component to overall physical health and overall quality of life,” Olson said. “We need a network of dentists sufficient for the number of people who need care in the state, we need training specific to sedated dentistry and a place to provide that care, and we need adequate payment for those services.”
Money to directly address the issue was actually designated for the problem a few years ago but is only now working towards implementation.
In the 2019-2021 state budget approved by the state legislature and Gov. Tony Evers’ administration, $2.5 million was appropriated to specifically increase payments to dentists for providing dental care to people with cognitive or physical disabilities who needed anesthesia during care. Of that, $1 million was appropriated for 2019-2020 and $1.5 million for subsequent years.
However, state officials at the Department of Health Services say they’ve only started in the last few months working out ways to use that money to increase reimbursements, a conversation that includes negotiations with the federal government for targeted payments to dentists.
“Over the past two years, the department has had to pivot to lead on the Covid-19 response, vaccine administration,” DHS Medicaid director Lisa Olson said. “We’ve pulled a number of folks into that effort, but now we are able to refocus our efforts and ensure that we have access to services such as sedation dentistry.”
The earliest that those targeted payments could be realized would be in January 2023, Olson said, but ongoing federal negotiations mean that target deadline may be pushed farther down the road.
Another solution already implemented may also contribute to relieving the sedated dentistry burden, officials noted.
Starting in January of this year, Wisconsin’s Department of Health Services has put a 40% Medicaid reimbursement increase into place for all types of dental services, which may help address the issue of specialized care in the future.
“We certainly know how hard and frustrating it must be for parents, for individuals to not be able to find those services,” Olson said. “They and their children need to be healthy and pain-free and we’re committed to increasing access so that is no longer the case.”
State representative: Medicaid expansion could resolve problem
A repeatedly-denied expansion in Wisconsin of Medicaid under the federal Affordable Care Act would have helped solve the problem, Rep. Dianne Hesselbein (D-Middleton) believes.
“If we had done that, we would have been able to help people pay dentists a fair rate,” Hesselbein said, who is now running for the state senate where she wants to target this issue for bipartisan legislative remedies in the next session.
“This is what government should do: help people that need it the most. And we need to do more for them.”
Republicans in the state legislature, beginning under Republican Gov. Scott Walker, have repeatedly rejected expanding access to Medicaid in Wisconsin, arguing it wasn’t needed and would increase dependency on the federal government. The state Legislative Fiscal Bureau estimated in 2018 that expansion would have saved Wisconsin $2.8 billion over the years.
Wisconsin is one of just twelve states that have not accepted federal money to expand Medicaid, according to Kaiser Health News. An influx of federal expansion dollars could be used to continue increasing reimbursements for dentists providing sedated care, Hesselbein said.
“That reimbursement is nowhere near where it should be, and when providers are providing this care, they lose money every single time,” Hesselbein said. “Every single time.”
Resources recommended by DHS:
- ForwardHealth Member service line 1-800-362-3002.
Available Monday through Friday, 8:00 a.m. – 6:00 p.m. (Central Time, with the exception of state-observed holidays). Members should call Member Service for enrollment and benefit information.
- Dental ombudsman James Foerster James.Foerster@wisconsin.gov 800-947-9627 option # 4
Investigative Reporter Naomi Kowles can be reached at firstname.lastname@example.org
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