New data shows dental care use among Minnesota children is dropping


According to new data from the American Dental Association’s Health Policy Institute, dental care use among Minnesota children is dropping.


In 2010, 44% of Minnesota children on Medicaid visited a dentist in the previous 12 months. In 2015, that percentage fell to 41.1%. Nearly 6 in 10 children from low-income Minnesota families are not receiving the dental care they need, another sign that the state’s dental access crisis continues to get worse.


Minnesota was one of just 12 states in the U.S. that saw dental care utilization among children on Medicaid drop from 2010 to 2015.


Among families with private dental benefits, there was also a drop in the percentage from children seeing a dentist — from 69.5% in 2010 to 68.6% in 2015.


Data for Minnesota and all states is available on this document: click here –> ADA_HPI_Infg_KidsUtilization

KNSI-AM: Interview with Dr. Michael Helgeson


Dr. Michael Helgeson, Co-Founder and CEO of Apple Tree Dental, was interviewed by guest host Kurt Zellers, former Speaker of the Minnesota House of Representatives, on KNSI-AM about Minnesota’s dental access crisis and the Help Minnesota Smile campaign being led by the Minnesota Dental Association.


You can listen to the interview here:

Detroit Lakes Tribune: It’s like pulling teeth: Finding pediatric, rural dentists poses huge challenge

Minnesota may be first in our hearts but, unfortunately, our teeth are a very different story.

According to the Minnesota Dental Association’s webpage, “Minnesota currently ranks dead last–50th of the 50 states–when it comes to Medicaid funding rates for pediatric dental services.”

That ranking is all too obvious to those working with children in Becker County.

An overwhelming need

“It’s almost reached a crisis point for the children in our area,” said Mary Frank, Health Specialist at Mahube-Otwa Community Action Partnership. “A lot of dentists are not taking any new clients with Medical Assistance. No one will see the children.”

The one area dental care provider that does go out of its way to assist underserved populations–Apple Tree Dental in Hawley, MN–is overwhelmed, according to Frank.

“They have so many clients to see, and there are over 1,000 people on their waiting list,” she explained. “And that’s not counting the people who call in every single day.”

Apple Tree Dental Center Director Suzanne Peterson explained that there are, in fact, currently 1,200 people on the Hawley waiting list and an additional 600 on the Fergus Falls waiting list. To make matter worse, the facility recently lost four dentists to private practices and other facilities.

“Because we’re non-profit, the reimbursement rates that we get from the health plans are very low,” she said. “It’s very hard to compete with private practices or some of the state-funded programs that are able to pay a higher salary to dentists. There is a shortage of dentists in this area that take the state-funded Medical Assistance programs and, with the rural population that we’re seeing, a lot of the population is on those state-funded plans or they have no insurance at all.”

Mahube-Otwa Executive Director Liz Kuoppala agreed, saying that the low reimbursement rates and an overall dental shortage contribute to the lack of coverage for children in the area.

“We’re concerned about all of these young children who need dental care,” she said, “because these children have nowhere to go. Because there’s a shortage of dentists, they prefer people who can pay so, just because someone has MA (Medical Assistance) doesn’t mean they’re being seen. “

In fact, according to the Minnesota Dental Association, “Well over half of Minnesota children enrolled in Medicaid have not received dental services in the past year–with the situation made worse by Minnesota’s lowest-in-the-nation ranking for reimbursement of government dental program fees.”

Facing difficult barriers

Stephanie Hogenson, Research and Policy Director for Children’s Defense Fund-Minnesota, explained that, even if families on Medical Assistance do manage to make an appointment, they can find themselves face-to-face with other hurdles.

“Families on MA often have other barriers, such as transportation or jobs,” she said. “Actually getting to an appointment is difficult and can be costly–if they have to take time off of work, for example.”

Hogenson said that families can be asked to travel hours for a simple dental appointment. With rural dental care in such high demand, many dentists who accept Medical Assistance only accept a certain number of patients–a number that is dangerously low in comparison to the number of individuals in need of dental care.

One other concern, she said, is that the public is unaware of the problems that can be caused by untreated dental issues.

“People think that dental care isn’t as important as, say, health care,” she said, “but dental problems can have long-term health impacts. Some of those things can be easily prevented.”

Frank agreed, explaining that the need for pediatric dental care has been a consistent one in the community but saying that it hasn’t gotten the attention it deserves.

“Just in visiting with friends and neighbors,” she said, “I don’t think that the community is aware of the huge need. We try to serve as many children as we can with the funds that we have, but we just don’t have these kinds of funds.”

While adults in the community may notice the need for dental care more than children, Debbie Skjonsberg, Health Services Director at Mahube-Otwa, found that children do pick up on the importance of visiting the dentist.

“I sat down next to this little girl one day, and she had never seen me before,” she said. “But she opened her mouth and showed me that she had five or six caps on her teeth. She was so proud that she got to go to the dentist.”

Forward motion

The verdict is in: rural areas need dentists. From pushing legislature to encouraging collaboration, a number of possible solutions exist; however, according to Frank, there are no quick fixes.

“There are so many issues that are connected that it’s a slow process,” she said. “But, if a child has a bad tooth in their mouth, we can’t let it go much longer than that.” Occasional pop-up clinics and days like “Give Kids a Smile” do exist, but offer short-term treatment for long-term problems. One such clinic, a two-day Mission of Mercy event held at Concordia in 2016, only solidified the need in Kuoppala’s mind.

“They saw almost 1,500 people that day,” she said. “That’s just one example of how much this is needed.”

Moving forward, Hogenson feels that one of the most important steps is to address the lack of dentists who want to work in rural areas. She explained that some programs, such as one offered by the University of Minnesota, encourage future dentists to return to rural areas. “Recruitment back to rural areas is key,” Peterson agreed.

Unfortunately, there are many other facets of the problem that still need to be addressed.

“We need dentists to understand the needs of the programs and why the reimbursement is the way it is,” Hogenson said. “We also need to eliminate barriers by providing transportation to appointments and by providing appointments outside of work hours.”

Apple Tree Dental, according to Peterson, is working to push legislation that will increase reimbursement rates, which she says will help other local dentists to serve rural populations.

“When we’re fully staffed–that’s with four full-time dentists and three-full time hygienists–we see between 70 and 85 patients,” she said. “Right now, we’re seeing around 55 patients a day, and the majority of our patients are on state-funded programs.”

The other important aspect, she explained, is prevention.

“We’re trying to encourage young families to seek dental care early,” she said. “One thing that we’ve been working on with the Early Childhood Network–through the Fergus Falls office–is to get the medical side of things to stress oral care with their new moms and to stress the prevention part of it, as well. Prevention is a really big thing.”

From the dental side of things to the childcare side of things, one thing remains the same across the board.

“There’s still a large, unmet need,” Peterson said. “I feel like we’re only hitting the tip of the iceberg.”


Forum Communications: Poor Minnesotans and dentists struggle to smile

ST. PAUL—Many low-income Minnesotans cannot afford to go to a dentist and many dentists say they cannot afford to serve those who receive state assistance.

For serving the poor, Minnesota pays dentists 27 percent of what other Minnesotans pay. Because of that, many dentists no longer accept patients on Medicaid, a federal-state medical coverage program for the poor known in Minnesota as Medical Assistance. Other dentists limit how many MA patients they serve.

Baxter, Minn., dentist Dr. Kevin Dens says on Thursday, March 2, 2017, that while poor Minnesotans have little dental access, it is worse in rural Minnesota. Don Davis / Forum News Service

“Many dental clinics, and especially small clinics in the rural parts of the state, cannot afford to serve those patients,” Baxter Dentist Dr. Kevin Dens said Thursday, March 3, as the Minnesota Dental Association lobbied lawmakers to increase spending on dental programs up to $120 million in the next two years.

Minnesota’s Medical Assistance reimbursement rate for dentists is the worst in the country for children and fourth worst for adults.

“We are failing our children and we are not doing much better for our adults,” said Dens, who is president of the dental group.

The situation is worse in greater Minnesota, where dentists overall are in short supply. Dentists say the low state payments means they cannot afford to keep workers, which affects all patients.

Minnesota taxpayers are affected, Dr. Mary Seieroe of Hennepin County Medical Center said, because thousands of people go to emergency rooms when dental issues get out of control. ERs are not equipped to cure the problem, just to treat symptoms, such as giving patients narcotics or antibiotics.

Most dental problems that send people to the ER could have been avoided with regular dental care, she said.

Greater Minnesota residents are especially affected, with just one dentist per 10,000 people in some areas.

Dens said a Detroit Lakes woman recently drove 89 miles to his office because she could find no dentist at home who would accept MA.

Stephanie Hogenson, research and policy director for Children’s Defense Fund-Minnesota, explained that, even if families on Medical Assistance do manage to make an appointment, they can find themselves face to face with other hurdles.

“Actually getting to an appointment is difficult and can be costly, if they have to take time off of work, for example,” she said.

Hogenson said that families can be asked to travel hours for a simple dental appointment.

“Rural areas have some pretty acute problems,” said Dr. Michael Helgeson of Apple Tree Dental.

One county has no dentist and some have just one.

In Lewiston, in southeastern Minnesota, Dr. Michael Flynn is worried about the future.

“I am going to be 64 in two weeks,” said Flynn, adding that half of his patients are on Medical Assistance. “Unless there is a change, there will not be a replacement for Dr. Flynn in Lewiston.”

Young dentists may face repaying school loans of $250,000. Dens said they often cannot earn enough in rural areas, so opt for places like the Twin Cities.

“If you are a young dentist by yourself, and have to pay your bills, you always are going to take a private-pay patient who can pay you…” Dens said. “It is a business.”

Helgeson said that “we have reached a crisis point,” with small state payments resulting in employees leaving Minnesota dentists.

In northwestern Minnesota, Helgeson said, some go to North Dakota, which pays dentists twice to care for the poor as much as Minnesota.

Nearly 1,200 people are on a waiting list to get a dentist in northwestern Minnesota alone, Helgeson said.

Many end up in ERs, he said. “It is not something that can be sustained.”

ER visits by people on state assistance may cost taxpayers $50 million annually, dentists said.




Minnesota News Network: Dentists want state to increase funding for dental care

Dentists are asking state lawmakers to increase the state match for dental care at least 100 million dollars over the next two years, saying low-income patients aren’t getting treatment they need because Minnesota has the lowest Medicaid payment rates in the nation.

Doctor Mike Flynn from Lewiston says he’s almost 64 years old and his business is at a crisis point. Flynn says, “Unless there’s a change, there will not be a replacement for Doctor Flynn in Lewiston. Under the current system it is not sustainable.”

The Minnesota Dental Association says if patients with serious problems receive dental care, taxpayers will save the cost of emergency room visits.


Rochester Post Bulletin: Dentists plead for boost in reimbursement rates

ST. PAUL — A Lewiston dentist traveled to the Capitol on Thursday with a grim message — unless lawmakers take action to boost the state’s Medicaid reimbursement rates, more and more Minnesotans will go without care.

Dr. Michael Flynn worries that when he retires there will be no one to care for the region’s low-income patients.

“I’m going to be 64 in two weeks. Unless there is a change, there will not be a replacement for Dr. Flynn in Lewiston. Under the current system, it is unsustainable,” he said.

Flynn joined several other dentists at a Capitol press conference to speak in support of a bill sponsored by Rep. Nels Pierson, R-Rochester, that would increase the state’s Medicaid reimbursement rates. Minnesota has the lowest reimbursement rates for pediatric dental services in the nation.

Pierson’s proposal would invest up to an additional $120 million into Medicaid reimbursement rates for dental care in the next two-year budget. The Rochester lawmaker told reporters the state’s low rates are a “stain on Minnesota’s great history” and it is time to fix it.

“These low payment rates have a real impact on the ability of dentists to provide care for low-income Minnesotans, and this issue is particularly acute in greater Minnesota. We can do better, and I am hopeful this year we will make significant progress on the issue,” Pierson said.

A similar bill is being sponsored in the Senate by Sen. Julie Rosen, R-Vernon Center.

In Minnesota, the reimbursement rate for Medicaid patients is 27 percent of what patients who aren’t on public assistance pay. That compares to reimbursement rates of 32 percent in Wisconsin, 42 percent in Iowa and 63 percent in North Dakota.

Gov. Mark Dayton’s budget proposal would increase reimbursement rates by 54 percent. By comparison, Pierson’s bill would boost the rates by 100 percent. Flynn said he appreciates the governor’s proposal but it doesn’t go far enough. He said he is having trouble finding dental assistants to work in his office. Many of them are going to nearby La Crosse, Wis. instead.

“My business as a dentist in Lewiston is at a crisis point, and it’s time for Minnesota to assist rural practices,” Flynn said.

When patients don’t have access to a dentist, they often end up in the emergency room for care. That is a costly alternative that often fails to get to the root of the problem, according to Dr. Michael Helgeson, CEO of Apple Tree Dental. The clinic has six offices in the state, including Rochester. He shared the story of a 90-plus-year-old woman with dementia who had been unable to see a dentist. She showed up several times at Mayo Clinic for an untreated infection that doctors had trouble diagnosing. Once the woman got her teeth checked, it was discovered she had 11 abscess root tips in her mouth.

“Can you imagine? You can’t communicate. You’ve got these infections. You are in and out of the hospital. That’s just not right in Minnesota. Vulnerable children, vulnerable adults — people should not have festering infections in their mouths,” Helgeson said.

Neither Pierson’s nor Rosen’s bills have received a committee hearing yet. The state is projected to have a $1.65 billion budget surplus. But there is expected to be plenty of competition for those dollars as lawmakers consider a long list of tax cuts and spending request.

To help the proposal’s chances, the Minnesota Dental Association is preparing to launch an ad campaign soon called “Help Minnesota Smile.” The slogan? “It’s hard to smile when you’re in last place.”

The association’s president, Dr. Kevin Dens, said it is has taken 30 years for Minnesota to drop to the bottom of states when it comes to reimbursement rates. The proposed $120 million investment would at least move Minnesota to the middle of the pack.

He added, “Right now, Minnesota should be too embarrassed to smile. Ranking last in the nation is not the way we do things in Minnesota.”


WCCO-TV: Minnesota Dentists Say State Facing ‘Worst-In-The-Nation’ Dental Crisis

ST. PAUL, Minn. (WCCO) — Minnesota dentists say the state is facing a worst-in-the-nation dental crisis, and they are mounting a “Help Minnesota Smile” campaign at the Capitol.

The state ranks dead last in funding for pediatric dental services for the poor.

“Right now, Minnesota should be too embarrassed to smile,” Minnesota Dental Association president Dr. Kevin Dens said. “Ranked last in the nation is just not the way we do things in Minnesota.”

The Minnesota Dental Association is asking the legislature to spend 100 million dollars to raise the reimbursement rate. Because it’s so low, many clinics can’t treat poor patients, who end up in emergency rooms.