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Low Medicaid Payments Leave Many Without Access To A Dentist

All this week, as part of our Zip Code: The Hidden Vital Sign series, ideastream has been looking at the things beyond a person’s control that influence health, such as crime, poverty, food insecurity, recreation and neighborhood green space. This next story focuses on how some rural areas lack access to dental care. 

Julie Roberts bought this practice in an old colonial style house near downtown Norwalk, the biggest town in Huron County. Inside it feels more like getting your teeth cleaned in your aunt’s living room than in an office. There’s a wall of windows next to one of the chairs where the sun pours in. Out front there’s a wraparound porch.

A single station at this or any dentist’s office - what’s known as an operatory, with a chair and the tools and the motor to run it all – costs about thirty five thousand dollars. So, Roberts says, most dentists don’t start up a new business anymore.

“I'm kind of the dinosaur where you're in a solo practice, I've been in a solo practice for 23 years and usually the practices are a group practice," says Roberts.

She says about 65 percent of her fee goes toward overhead. And because the reimbursement for Medicaid patients is low, covering only about a half of her costs, she can’t take those patients.

"If they would bring it up to the average overhead, even close to it, I think you would see a huge amount of dentists accepting Medicaid." says Roberts.

That creates an issue for rural areas, like Huron County where almost 1-in-5 rely on Medicaid. Lindy Cree is executive director of the Dental Center of Northwest Ohio, a100-year-old Toledo-based organization providing dental care to the underserved. Cree says they were running a mobile clinic in Huron. First in Norwalk, then because of high demand they added one in the southern part of the county.

“It’s not the most efficient way to do dentistry but it works and it takes care of people who have a need until you can figure out another model," says Cree.

Cree’s organization is a non-profit run with donations and contributions. They’ve had to shut the mobile clinic down for now because it’s 11-years-old and needs costly repairs. Otherwise, federally qualified health centers, or FQHCs, usually fill the need in underserved areas nationwide.

An FQHC receives funding from the federal government to make up for the low Medicaid reimbursement and to help cover the uninsured. But that, says Cree, still leaves gaps.

“You’re talking about limited resources. There’s not enough money in perhaps the system to provide an FQHC to every single county," says Cree.

In Huron County, the only FQHC serves migrant workers. With one dentist for every 3250 people, there’s clearly a need for more. So why haven’t any been started up here?

Randy Runyon of Ohio’s Association of Community Health Centers says the Affordable Care Act set aside billions to open FQHCs.

“So we've added a number of entities in Ohio. When I started seven years ago, I think there were 35 health centers, now there are 49. And the big expansion has been growth in sites," says Runyon.

The centers often began decades ago, usually when a hospital or a non-profit or the county health department opened a clinic, then they sought federal support when it became available. That never happened in Huron. The region also has to apply to the federal government to qualify as medically underserved. Huron hasn’t received that designation.

The surrounding counties – Erie, Lorain, Sandusky and Richland - all have FQHCs. Huron County’s health department is in the middle of a years-long needs assessment. But it’s not clear if that’ll lead to more clinics in this rural county. SOQ.

To see and hear more from our Zip Code: The Hidden Vital Sign series, click here

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