VT Digger: Advocates, Dentists Prepare to Face Off Over Licensing Dental Practitioners

MORGAN TRUE JAN. 25 2015, 2:23 PM 


State officials, advocates and providers agree that not enough low-income Vermonters are getting in to see a dentist, but a fight is brewing in the Legislature about how to change that.


On one side is the Health Department and a coalition of advocates that will once again push the state to license dental practitioners who would be able to provide many of the same services at the discretion of a dentist. Expanding the dental workforce would allow practices to treat more patients and expand their reach into underserved rural areas, they argue.

Alaska and Minnesota are the only states to license dental practitioners. Fifty-four countries and territories, including highly developed nations, have an equivalent professional designation, according to the Health Department.

The Vermont Dental Society says the creation of a new dental practitioner position won’t solve broader systemic problems that affect patient access. The dentists also question whether the proposed educational requirements for dental practitioners are sufficient.

Instead of licensing a new class of providers, the dental society wants to recruit more dentists and step up investment in existing programs, including school and nursing-home based oral care programs.

The Dental Society summarizes the initiatives in a Dental Action Plan, which was released last week in conjunction with a public relations push to highlight the effectiveness of Vermont’s dental health system.

The society spent $40,000 to air a feel good TV spot on local stations through the end of January.

Beth Nolan with the nonprofit Voices for Vermont’s Children says previous efforts to recruit more dentists and expanding programs in nursing homes and schools has not led to improvements in dental health for low-income Vermonters who have difficulty finding dentists who will take Medicaid patients.

Without an alternative workforce model for dentistry, low-income patients will continue to be denied access to care, Nolan said.

Vermont is the first state in the nation that offers payment for children’s dental care through an expanded Medicaid program known as Dr. Dynasaur. But many low-income children aren’t getting the dental care they need, and the state Medicaid program is paying $2.5 million annually to treat emergency tooth decay problems for children under the age of 6.

Low-income children are more than two times as likely to experience untreated tooth decay, according to Vermont Department of Health figures.

Only a quarter of the children in the Medicaid system receive dental care even though the program offers full coverage of oral health services. Half of adults in the program, who have a maximum $510 yearly dental benefit, get dental care.

Ninety-one percent of Vermonters with annual incomes $75,000 or more saw a dentist in the past year, as compared with 50 percent of low-income adults, making $25,000 or less.

The dental society says it will put more resources into recruiting dentists, but past efforts have fallen short.

The governor’s proposed budget cuts the Health Department’s student loan repayment program, which helps recruit and retain dentists and other health professionals.

Advocates say licensing dental practitioners would keep the situation from worsening as more dentists retire in the coming years. More than one third of Vermont dentists are 65 or older.

Officially, the shortage of dentists in Vermont isn’t as dramatic in other places, as defined by the dentist to population ratio.

There are 368 dentists in the state, or roughly one dentist for every 1,700 residents. Health professional shortage areas have a 1 to 5,000 ratio, according to the federal Health Resources and Services Administration.

Vermont’s low ratio masks the reality for many people who can’t afford dental services or can’t find a dentist that will accept Medicaid payments, according to Harry Chen, the commissioner of the Vermont Department of Health. Expanding the dental workforce would spread the growing Medicaid population across more providers, he said.

Thirty percent of dentists refused to accept new Medicaid patients in 2011, according to a Green Mountain Care Board study, and the number of dentists who continue to take Medicaid patients was unevenly distributed throughout the state.

Medicaid’s well publicized underpayments are a major reason for that, and the Affordable Care Act’s expansion of Medicaid eligibility has exacerbated the problem, said Vaughn Collins, executive director of the Vermont Dental Society. Collins said he welcomed Gov. Peter Shumlin’s proposal to boost Medicaid rates, he hasn’t been told whether dentists would be included in the increase.

Sen. Claire Ayer, D-Addison, chair of the Health and Welfare Committee, introduced S.20, which would license dental practitioners. Her committee will take another round of testimony to hear from providers who support and oppose the proposal.

After that, the bill would need approval from the Government Operations Committee, which is responsible for issuing new licenses, before it could reach the Senate floor.

The same bill, now before the House Government Operations Committee, was introduced by Rep. Tony Klein, D-East Montpelier.