But then, page after page, number after number, and conversation after conversation lead to nothing. Every dental clinic says it is not accepting new patients on Medicaid. They all direct you to one clinic in town; when you call, you’re added to a waitlist — which is three years long. Eventually, your dental insurance provider finds an appointment for you, but it’s in the Twin Cities. You do not have enough time off from work to make the trip for just one appointment.
Out of desperation, you pull the troublesome tooth out yourself.
This exercise in imagination is based on the lived experiences of Medicaid recipients across rural Minnesota. Adults on Medicaid carry the burden of dental disease and tooth loss in rural Minnesota, with more than 220,000 individuals impacted every year, according to the Minnesota Department of Human Services. Many rural Minnesotans who rely on Medicaid for dental care have been met with years-long waiting lists, clinics which will serve patients on commercial plans but will not see them, or long car rides into the Twin Cities for the most basic care.
This lack of local and accessible dental care has resulted in daunting remedies — from home extractions to routine trips to the emergency department, and from repairing cracked teeth with super glue to using dentures made for someone else.
One of the main causes of poor dental outcomes for adults on Medicaid is a lack of dental visits: 73.9% of Minnesota adults have had at least one past-year dental visit while only 29.1% of adults enrolled in Medicaid have had the same, according to the Minnesota Department of Health.
Additionally, Minnesota has some of the lowest Medicaid reimbursement rates for dental services, reports the American Dental Association. And there is a provider shortage: 55.2% of Minnesota counties are “Dental Health Professional Shortage Areas,” as identified by the state health department.
Rep. Lisa Demuth, R-Cold Spring, recently authored a bill to address the student-loan burden faced by new dentists, which often deters them from practicing in rural Minnesota. Since 1990, student-loan debt amounts for dental providers have increased over 500%, with the average 2019 dental-school graduate carrying a balance of more than $292,000.
Expanding the programs proposed by Rep. Demuth is a good starting point, but there is nothing in her bill (H.F. 620) to specifically tackle the difficulties faced specifically by those on Medicaid.
To make dental care more accessible across the state, for all Minnesotans, our outdated reimbursement rates need to be increased. While increasing rates would be expensive, providing additional access to care would start to prevent the need for some of the most expensive dental procedures. Bringing Minnesota Medicaid rates more in line with commercial insurance reimbursement rates would stop disincentivizing providers from accepting Medicaid patients. Making this change would make it financially viable for additional dental providers to accept Medicaid patients. This would increase access to preventative care and reduce the utilization of emergency rooms and other costly dental procedures. This would also help adults on Medicaid in rural parts of Minnesota access the care they need.
Jourdan Togstad of St. Paul is a student in the School of Public Health at the University of Minnesota and works as health and wellness coordinator for Mental Health Resources, which has an office in Duluth.