Opinion | I’m disabled, and it took me 15 years to find a dentist in Michigan

Paul Palmer is chairman of the Michigan Developmental Disabilities Council

It took me 15 years to find a dentist.

As someone who was born with cerebral palsy, doing everyday things is sometimes a challenge. What shouldn’t be a challenge for somebody like me is finding a dentist, but unfortunately that’s an obstacle many disabled Michigan residents face.

The U.S. Census Bureau estimates that nearly 1.4 million Michigan residents may be living with a disability, whether physical, developmental or both. According to a 2015 study, the most difficult barrier to oral healthcare facing adult patients with special needs is finding a dentist willing to treat them.

Finding access to a dentist isn’t a problem unique to the disabled community. In Michigan, 77 of our 83 counties are considered “dental shortage areas,” which means there aren’t enough dentists to serve the residents living there.  

A number of vulnerable populations are affected by limited access to a dentist, including those living in rural areas, children, pregnant women, low-income families and seniors.

For those who do have a dentist relatively near their home, the next hurdle is whether that dentist will accept their insurance. Although people with disabilities, very low-income families and pregnant women are eligible for fee-for-service Medicaid, most dentists do not regularly see adults on Medicaid in our state.

In fact, according to the state Department of Health and Human Services, of Michigan adults over 21 on Medicaid, only 27 percent visited a dentist in 2015. While there are 6,641 active licensed dentists in the state, only 661 saw one or more adults on this type of Medicaid ― just one out of 10.

Michigan has 45 Federally Qualified Health Centers that serve uninsured and Medicaid clients. However they report chronic understaffing of dentists at their clinics. So even patients who are able to get to a health center for care may be waiting months to have a cavity filled or a procedure done.

Senate Bill 541, introduced by Sen. Mike Shirkey, R- Clark Lake, could help expand access to care to those who are currently going without. This legislation would authorize a mid-level dental provider called a dental therapist.

Through appropriate training and licensing, these providers would be able to expand access to routine oral care, while working under the supervision of a dentist. Dental therapists would perform basic procedures, such as filling a cavity. The bill requires dental therapists to practice in high-need settings, such as a public clinic or a location where at least 50 percent of the patients are on Medicaid, uninsured or face other significant barriers to getting dental care. This will help ensure people like me will have more dental providers willing and able to treat them.

Because I have finally found a dentist who is extremely patient and kind and accepts Medicaid, I feel like a person. But for those who can’t find a dentist who will see them, dental therapists would make a positive impact on Michigan residents, particularly those with disabilities like me.

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Comments

Matt
Thu, 09/20/2018 - 1:13pm

One better why not let dental hygienists practice out from under their dentist? Then they could refer those needing additional care on to dentists. Never mind because our state government officials will never stand up to the dentists and trial lawyers. Yet they say they care.

TJ
Fri, 09/21/2018 - 8:58am

Next time you go to the dentist, ask how much Medicaid reimburses for care. Then you'll realize why so many opt to not accept it. I asked years ago and my dentist said he'd rather see patients for free (which he does) than deal with Medicaid. All they do is hassle dentists and staff and then pay them an extremely tiny amount for their trouble.

joel strom
Sun, 09/23/2018 - 5:43pm

It is with great frustration that I read this article. So many physically challenged patients need dental care and those with Medicare/Medicaid (out here in CA it is Medi-Cal) have the toughest time obtaining any care at all. Wait lists at dental schools and private charitable clinics are truly way too long.

In CA we have two extenuating circumstances which only contribute to this problem.....despite the efforts of some, including myself, the State will not offer a "carve out" for dentist who are willing to treat special needs patients on Medi-Cal and who simply cannot accept all Medi-Cal patients due to a variety of factors, not limited to reimbursement rates. These dentists (including myself) are willing to accept Medi-Cal special needs patients even though the reimbursements are extremely low if only to be "good citizens" and help those in particular need. But we cannot obtain such a carve out.

The other issue is our increasing minimum wage. While many people support the concept of a higher minimum wage, there is still a math problem; upward pressure on office overhead coupled with the State's low reimbursement rates and heavy paperwork burden create extreme financial situations which already has resulted in dentists removing themselves from the Medi-Cal system.

I don't have all the answers, and in some states perhaps a mid-level provider is the answer. And as a believer in the states being incubators of innovation, I respect efforts in other states to figure out potential ways to help those in particular need. I also support a single standard of care and only those appropriately trained and proven capable to provide any dental services should be allowed to do so.

I am happy for Mr. Palmer but also agree that there are way too many patients in need of care and cannot get it.

Richard DDS
Mon, 09/24/2018 - 4:13pm

Interesting timing that your commentary is published while the bill is in the legislature. Do your homework and see what the passing of a Therapist bill has done to improve care in states that have them. Nothing. The therapists don’t want to go to underserved areas any more than Dentists or unrestricted Hygienists. Medicaid reimbursements are abut 30-40% of my fees and my office overhead is over 70% of collections. You do the math.

Karen U.
Fri, 11/09/2018 - 8:08pm

Citations?