Low Medicaid Reimbursements Crimp Patient Options

December 20, 2007
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For a month, Robin Barker lived in pain because of a tooth that needed to be pulled. As a Medicaid recipient, Barker had no other choice.

“I called and it took a month just to get in. If I wanted surgery it would have taken until Jan. 9,” the 42-year-old Ann Arbor woman said. “When you're in pain, you're in pain.”

Two years ago, she had four root canals performed at the University of Michigan Dental School in an effort to save some teeth. Because the procedure wasn't covered by Medicaid, she's $1,700 in debt and she may lose those teeth anyway because she can't afford the crowns, something Medicaid also won't cover.

Now with another tooth that needs attention, Barker isn't sure what she's going to do, saying, “I don't know because I can't afford it.”

The number of people eligible for Medicaid is rising in Michigan, but low reimbursement rates are leading fewer and fewer physicians and dentists to accept them as patients.

“Doctors are having to spend money out of their own pockets — not many are willing to do that,” said AppaRao Mukkamala, president of the Michigan State Medical Society.

Physician participation in the Medicaid program has dropped from 88 percent in 1999 to 64 percent in 2005, according to the MSMS.

Mukkamala, a Flint radiologist, said Medicaid covers only about half of the cost of care.

“Being a radiologist, it costs me $30 to take a chest X-ray and I'm only getting back $15 to $16. So every time I take a chest X-ray of a Medicaid patient, that money comes out of my pocket,” he said.

With around 1.5 million beneficiaries and only two-thirds of physicians accepting them, Mukkamala estimates that one-third of eligible participants lack adequate access to health care.

That lack of access also extends to dental care, according to the Michigan League for Human Services. The group said fewer than two-thirds of poor and low-income children in the state receive dental care, compared with 80 percent or more of children in families with higher incomes.

Amy Olson, director of First Call for Help at the United Way of Midland County, said she knows of only one dental clinic in the county that accepts Medicaid patients.

“People have called here and said they've called 1-800-DENTIST and numbers in the phone book and have been unable to find anyone that accepts Medicaid,” Olson said.

With only one participating clinic, it's hard to get an appointment, she said.

The League for Human Services reports that reimbursement rates for 14 of the 15 procedures covered by Medicaid are less than 1 percent of dentists' claims.

Jan Hudson, a senior policy researcher for the league, said, “Medicaid doesn't pay fair rates.” The Legislature cut reimbursement rates in 2003, 2005 and 2006, she said. Because of the low rates, coverage is at a critical stage, especially in specialty fields.

“There are physicians unable to make referrals for some procedures. It really is a major problem in Michigan,” she said.

Mukkamala agreed that access to specialists’ care in such fields as neurosurgery, ophthalmology, dermatology and urology is a problem.

“Even those doctors that see Medicaid patients may limit the number they see per day,” he said. “With only a few slots open every day, some patients are getting delayed care, which makes their condition worse and more costly to treat. It's a slippery slope.”

Adding to the access problem is a shortage of dentists in Michigan, a league report said.

In 2007, it said, 60 out of 83 counties, mostly in the northern Lower Peninsula and the Upper Peninsula, were designated full or partial “health professional shortage areas” for dental services.

The federal government has determined that those areas have insufficient dental care providers for the entire county or for specific groups, such as low-income residents.

But James McCurtis Jr., communications officer for the Michigan Department of Community Health, said dental care access is improving, thanks to the Healthy Kids Dental program started in 2000.

“Things are moving forward; things are looking good,” he said.

The program is a partnership between the state and Delta Dental, which increased its reimbursement rates to match those of Delta's commercial plan rates.

Currently there are 59 counties covered by the program. Not covered are Grand Traverse, Wexford, Mason, Osceola, Oceana, Muskegon, Newaygo, Mecosta, Montcalm, Ottawa, Kent, Bay, Ingham, Kalamazoo, Calhoun, Jackson, Washtenaw, Cass, Berrien, Wayne, Oakland and Macomb counties.

Expansion is planned into Saginaw and Genesee counties next year, bringing the program to urban areas for the first time.

However, areas like Wayne, Oakland, Kalamazoo and Berrien counties, which have large concentrations of poor children, according to the league, continue to lack coverage.

Tom Kochheiser, director of marketing for the Michigan Dental Association, said his group would like to see the Healthy Kids Dental program expand into adult care.

“About 80 percent of dentists in the state participate in the program, so it’s really a win-win,” he said. HQX

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