Colo. faces provider deficit as residents gain benefits

Although hundreds of thousands of Coloradans will have new dental care benefits in 2014 because of healthcare reform efforts, state leaders are scrambling to find dentists to provide the care.

The number of patients will increase because of a new dental benefit, for adults with Medicaid, along with an expansion of eligibility and mandatory pediatric benefits from the Patient Protection and Affordable Care Act (ACA), according to a Denver Post story.

But many Colorado dentists say low reimbursement rates aren't worth the bureaucratic hassles. Additionally, the latest survey of Colorado dentists revealed that nine counties had no dentists at all.

About 335,000 current adults who receive Medicaid will gain access to dental care this spring, and tens of thousands more may join Medicaid under the ACA, according to the story. And there may be thousands more privately insured children with dental care included under "essential benefits" minimums of the state health exchange.

If only a quarter of those eligible take advantage of dental benefits, that could mean almost 100,000 additional people seeking care, said Karen Cody Carlson, executive director of the nonprofit Oral Health Colorado. Having benefits is a positive step, but it's creating access problems as well, she said.

About 1,000 of Colorado's 3,600 dentists are actively enrolled as Medicaid providers. Of those, just under 700 take enough Medicaid patients to bill more than $10,000 in claims in a year, which is a threshold for assessing participation.

After working for years to get an adult benefit included in Medicaid, dentists and public health officials are creating campaigns, including the Colorado Dental Associations's "Take Five" effort to get all dentists in the state to accept at least five Medicaid patients or families next year. Advocates are also working with Medicaid officials to streamline the signup and payment issues of the recent past.

Surveys show that more than 30% of Colorado adults haven't seen a dentist in the past year, and 20% to 25% of children have high levels of caries-inducing bacteria, the story noted.

Reimbursement has risen 4% this year and will go up 2% to 3% next year, bringing Medicaid patients closer to a break-even or slightly profitable proposition.